Person Centred Care and its
relationship to Legislation
Dr. Amanda Phelan
S
To be a person
S  Recognised
S  Past, present and future
S  Individual
S  Valued
S  Being
S  Equality
S  Operationalised through others
Personhood
S  'I-It” and “I-Thou” (Buber
1970)
S  ‘You become a person (as
opposed to an alienated and
isolated individual) when
you enter into relation with
people.” (Barich 1998)
Kitwood
S  ‘It is a standing or status that is bestowed upon one human
being, by others, in the context of relationship and social
being. It implies recognition, respect and trust” (Kitwood,
1997, p.8)’
“In these pictures we see with heart-breaking intensity
William’s efforts to explain his altered self, his fears and his
sadness.” Patricia Utermohlen (widow)
Kitwood 1997
Brooker 2007
S  V = Values people – Values and promotes the rights of the person
S  I = Individual’s needs – Provides individualised care according to
needs
S  P = Perspective of service user – Understands care from the
perspective of the person with dementia
S  S = Supportive social psychology – Social environment enables
the person to remain in relationship
McCormack &
McCance 2016
Malignant Social Psychology
Treachery
Disempowerment
Infantilisation
Intimidation
Outpacing
Labelling
Invalidation
Stigmatisation
Banishment
Objectification
Ignoring
Disparagement
Withholding
Imposition
Accusation
Disruption
Mockery
(Kitwood 1997)
De-humanising Care
Todres et al 2009
Human Rights
S  Cyrus the Great (539BC), the first king of ancient Persia,
conquered the city of Babylon.
Background
628)
1
(
t
h
f Rig
o
n
o
Petiti
Magna Carta 1215
US Bill of Rig
hts
1791
US
French Declaration
of the
Rights of Man and
of the Citizen (178
9)
1787
n
o
i
t
u
t
Consti
Human Rights (UN 1948)
European Convention on
Human Rights (1953)
Article 10 Freedom of expression
S  Article 2 Right to life
Article 11 Freedom of assembly and association
S  Article 3 Prohibition of torture
S  Article 4 Prohibition of slavery and
forced labour
S  Article 5 Right to liberty and security
S  Article 6 Right to a fair trial
S  Article 7 No punishment without law
S  Article 8 Right to respect for private
Article 12 Right to marry
Article 13 Right to an effective remedy
Article 14 Prohibition of discrimination
Protocol 1, Article 1 Protection of private property
Protocol 1, Article 2 Right to education
and family life
S  Article 9 Freedom of thought,
conscience and religion
Protocol 1, Article 3 Right to free elections
European Convention on Human Rights Act
(2003)
Citizen rights
S  Implies legitimate duties and
responsibilities
S  Allows a particular social identity and a
concept in defining state-individual
relationships (Phelan 2013)
S  Civil: Rights to liberty, freedom of
speech, movement, religious rights, the
right to justice, the right to own property.
S  Political: Right to vote and participate in
politics
S  Social: Right to an economic income and
to participate in social life.
Capacity legislation
S  Lunacy Regulation Act (1871): Wards of Court.
Responsibility with the President of the High Court.
S  Enduring Power of Attorney (1996)
S  Assisted Decision Making Capacity Act (2015)
S  Mental Health Act (2001)
Informed consent
S  Informed consent is based on the principles of autonomy and
privacy
S  Center of morally valid decision making in health care and
research.
S  Seven criteria : (1) competence to understand and to decide, (2)
voluntary decision making, (3) disclosure of material information,
(4) recommendation of a plan, (5) comprehension of terms ((3)
and (4)), (6) decision in favour of a plan, and (7) authorisation of
the plan.
S  A person gives informed consent only if all of these criteria are
met. If all of the criteria are met except that the person rejects the
plan, that person makes an informed refusal.
Law Reform Commission 2005
(Vulnerable adults and the law)
S  “To be autonomous and capable of self-determination
is a large part of what humans cherish in terms of
liberty and independence. Part of being an adult is the
right to make decisions independently, although in
reality many of us make them interdependently by
consulting with friends and family.”
Approaches to capacity
•  Based on characteristics of the individual
•  Across the board
•  Based on the outcome of the decision
•  Subjective: Unwise=lacking capacity
•  Time
•  Decision
Decision Making: Legal
comments
S  ‘…risk that all professionals involved with treating and helping
that person – including, of course, a judge in the Court of
Protection – may feel drawn towards an outcome that is more
protective of the adult and thus, in certain circumstances, fail to
carry out an assessment of capacity that is detached and
objective’.
S  ‘The emphasis must be on sensible risk appraisal, not striving to
avoid all risk, whatever the price, but instead seeking a proper
balance and being willing to tolerate manageable or acceptable
risks as the price appropriately to be paid in order to achieve
some other good – in particular to achieve the vital good of the
elderly or vulnerable person’s happiness. What good is it
making someone safer if it merely makes them miserable?’
Munby LJ (2010)
Re: M
S  In the end, if M remains confined in a home she is entitled to ask
“What for?” The only answer that could be provided at the
moment is “To keep you alive as long as possible.” In my view
that is not a sufficient answer. The right to life and the state’s
obligation to protect it is not absolute and the court must surely
have regard to the person’s own assessment of her quality of life.
In M’s case there is little to be said for a solution that attempts,
without any guarantee of success, to preserve for her a daily life
without meaning or happiness and which she, with some
justification, regards as insupportable.
(Jackson J.)
Westminster City Council v
Sykes (2014):
S  ‘Risk cannot be avoided of course. All decisions that involve
deprivation of liberty or compulsion involve balancing competing
risks, of which the risk that others may suffer physical harm is but
one. For example, detention and compulsory care or treatment may
risk loss of employment, family contact, self-esteem and dignity;
unnecessary or unjustified deprivation of liberty; institutionalisation;
and the unwanted side-effects of treatment’
S  ‘Therefore, it is her welfare in the context of her wishes, feelings,
beliefs and values that is important. This is the principle of
beneficence which asserts an obligation to help others further their
important and legitimate interests. In this important sense, the judge
no less than the local authority is her servant, not her master.’
(Eldergill DJ)
Thank You
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00353 1 7166482