• Autonomy and protection in self-neglect work: the ethical complexity of decision-making

      Braye, Suzy; Orr, David; Preston-Shoot, Michael (Taylor & Francis, 2017-02-20)
      Self-neglect, in which an individual does not attend to their hygiene, health or home surroundings, is one of the most challenging aspects of adult social care practice. In England, its inclusion within the remit of adult safeguarding, as a result of changes in adult social care law introduced under the Care Act 2014, has thrown into relief the ethical dilemmas arising from tensions between respect for autonomy on the one hand and the exercise of a protective duty of care on the other hand. This paper draws on serious case reviews and safeguarding adult reviews in self-neglect cases, along with findings from adult safeguarding research, to propose that an appropriate balance between these two moral imperatives is not always achieved in self-neglect practice. It considers why autonomy appears to be privileged over other considerations, illustrating the complex interplay between law and ethics that gives autonomy pre-eminence. It then considers how a more nuanced, situated and relational approach to autonomy can enable practitioners to move away from dichotomous interpretations of the moral imperatives present in self-neglect work, and can support more nuanced understandings of the ethics of professional decision-making. Finally, it considers the personal and organisational implications of this enhanced ethical literacy.
    • Meaning in hoarding: perspectives of people who hoard on clutter, culture and agency

      Orr, David; Preston-Shoot, Michael; Braye, Suzy; University of Sussex; University of Bedfordshire (Taylor and Francis, 2017-12-12)
      Hoarding has become increasingly prominent in clinical practice and popular culture in recent years, giving rise to extensive research and commentary. Critical responses in the social sciences have criticised the cultural assumptions built in to the construct of ‘hoarding disorder’ and expressed fears that it may generate stigma outweighing its benefits; however, few of these studies have engaged directly with ‘hoarders’ themselves. This paper reports on in-depth, semi-structured interviews with ten individuals living in England, who received assessment and intervention for hoarding from Social Services. Their narratives drew on the cultural repertoire of values and discourses around waste and worth, the mediation of sociality and relationships through material objects, physical constraints on keeping order, and the role played by mental health. Analysing these perspectives anthropologically shows how dominant models of hoarding, such as the DSM-5 paradigm, potentially lend themselves to reductionist understandings that efface the meaning ‘hoarding’ may have and thereby deny agency to the person labelled as ‘hoarder’. More culturally informed analysis, by contrast, affords insights into the complex landscape of value, waste, social critique, emotion, interpersonal relationships and practical difficulties that may underlie hoarding cases, and points the way to more person-centred practice and analysis.