Duty of Care Dilemmas

Healthcare providers have to ensure the best possible care for individuals, which sometimes may lead to conflict and dilemmas between the duty of care and the individuals.  A dilemma is a situation in which difficult choices have to be made between different options (that are equally undesirable). The dilemmas can arise when fulfilling your duty of care, especially when it comes into tension with an individual’s right to make their own choices.

Consider a situation where you’re supporting an individual who has been diagnosed with bipolar disorder. It’s time for their medication, but when you offer it, they refuse. The individual explained that they believe the pharmaceutical industry is conspiring to poison them. This is a dilemma in which several aspects are involved. First, you acknowledge that this person is an adult and has the legal right to make decisions about their own body and treatment. Second, you know the person’s condition may worsen without their medication. Third, you also know that you cannot force medication on someone, and you certainly cannot hide it in their food, because doing so would be illegal.

In this situation, you are responsible for upholding your organisation’s policies and procedures, and for making sure all actions taken are safe and lawful. In this regard, the approach you take will depend on the individual and what is outlined in their care plan. Perhaps you’ve supported them before, and you know that if you simply say, “Okay, no problem, let me know if you change your mind,” they often come back to ask for the medication. That might be the most respectful and effective response. In other cases, you may choose to gently engage in conversation to listen to their concerns and try to provide reassurance. You might explain that the medication is intended to support their health and not to harm them.

Whatever approach you take, your goal is to ensure the person has all the information they need to make an informed choice. But if the person continues to refuse their medication despite your best efforts, and you believe there is a serious risk to their wellbeing, then it’s essential to escalate the concern. You may need to contact their GP or seek additional support or advice. Furthermore, you should also report the incident to your manager and record it in line with your organisation’s policies and procedures.