Self-determination and Paternalism in Community Care: Practice and Prospects

Self-determination is long established as a key principle of social work ethics, but has seldom been the subject of empirical research. This article reports on a qualitative study of the principles and beliefs of community care social workers in a local authority. It is shown that, while workers retain strong attachment to traditional ideas about self-determination, they also appreciate that paternalistic intervention is sometimes justified. The more recently fashionable concept of empowerment appears to have had little useful impact. The paper argues that, while the persistence of self-determination is a strength of social work and should be defended, traditional practice ethics are weak on the political issues embedded in community care. Five key issues are identified: the threat to individualized service under care management; the problematic determination of mental competence; social ambivalence about the extent of family responsibility for dependent adults; the threat to equity arising from variable interpretations of self-determination; and the excessively elastic interpretation of empowerment.