The focus of attention of this essay is on ‘The potential for professional misuse of power by health care professionals when working with vulnerable groups’. The author of this paper will address a number of issues as they relate to the topic question, which includes, describing a vulnerable group nominated for discussion and why they are at possible risk, there for outlining examples of misuse of professional power and putting forward strategies to address situations that arise, offering approaches that prevent the misuse of power from happening in the future and summarising legislation and professional codes of conduct involved with client care of the vulnerable group. The group nominated to illustrate the potential for professional misuse of power is those who live with a mental illness. There are a number of reasons why this particular group has been chosen and they include, the idea and notion of marginalisation, and social stigmas associated with having a mental illness. This health care issue is an issue that crosses all social and economic boundaries and divides society. In days gone by, the views held by many in our communities had been consistent with the notion and idea of ‘out of sight out of mind. Thankfully community attitudes are changing so to health care practices towards the treatment of a mental illness. In spite of these changes there still exists the potential for mistreatment and the misuse of power by some professionals who not only exacerbate the problem of the patient but also bring the profession into disrepute.
The following will now discuss as to the reasons why by giving examples of misuse of power that some health care professionals are entrusted with. History teaches us many lessons, the accounts of abuse of mental health clients and patients are many. In describing examples of abuse by care workers the concept of what are boundaries will be discussed. Discussed in the context of what constitutes what is acceptable and what is deemed inappropriate. That is, from the view point of noting the points where medical staff can assert power and to what extent this means in terms of patient rights.
Boundaries can be looked at from a number of points of view. For example boundaries can be seen as those sets of rules that establish the grounds by which one engages. For instance boundaries can be established by clearly defined sets of ordered and structured statements that indicate the manner and way in which clients are dealt with. (http://www.nrgpn.org.au/ 2nd August 2010).
They can come in a number of forms that appear in the shape of; Acts or laws, policies, work place practices and so on. Take the Mental Health Act, for this assignment the Author has used the example of Act content from the Western Australian Act 1996 where Part 7 discloses Protection of patients’ Rights to be given). (Http; /webcache,googleusercontent.com 27th July 2010).
Professional boundaries can be described as those conditions that distinguish between sets of behaviour that may lessen the health outcomes of the patient. The idea and notion of what boundaries represent and mean can best be summed up by saying that they are those sets of conditions that bring about an acceptance of each parties roles and responsibilities in a particular relationship.
In summary they set the standard where by clearly defined sets of conditions establishes a manner of conduct and behaviour that informs the worker what they ought to do at the same time informing them of what this means in terms of their relationship with the patient. In the context of examples of the misuse of power, one could quite easily conclude that the misuse of power occurs when a worker crosses those professional boundaries of trust and neglects their commitments and responsibilities which in turn create the potential for the inappropriate care and treatment, which results in poor outcomes for the client.
With respect to the concern of preventing abuse by health care professionals, the issue of standards and transparent diagnosis and evaluation of a mental illness comes to mind. In turn the issue of creating and maintaining sets of standards are important factors in preventing abuse. Important because they (the standards) establishes mode and method of not only treatment but of means and measures of developing a more structured way of not only appropriately assessing those with an illness but also ensuring that the diagnosis falls within particular guidelines.
In terms of transparent practices, clearly defined guidelines need to be put in place that shows an open and ordered means by which patients are then processed and dealt with. Standards are the key to managing the prevention of abuse of the mentally ill. Standards from the point of view of realising measured and ordered approaches to the practices of caring for the mentally ill as well as guaranteeing fair and equitable management of the patients concerns.
In dealing with the issue and concern of developing approaches to manage the potential for eliminating abuse from happening in the future the proposal for a much broader campaign of drawing the attention of the communities understanding to what is going on makes for a point from which to start.
Measures for eliminating abuse must take on a much broader and wider audience. The issue is both a social one as well as a political one. The effect of such a campaign must take place within all quarters of society. The failure to address the concern as a much broader social issue can have disastrous consequences not only on the client affected by abuse but also on the profession it self. There must be a greater emphasis placed on intake procedures and screening as well as safety checks put in place within the profession. A greater level of management practices that are consistent with standards that place emphasis on treatment outcomes and doctor/nurses skills training must take precedence.
Medical staff must also be aware of all resources like the Australian Health and Ethics Committees resource kit outlining good medical practice in doctor/nurse patient communication. These set of guidelines focus on how doctors (communicate with patients and the need to discuss treatment plans including information on risks, and, restricted circumstances when immediate provision of information may not be desirable). (http://www.nhmrc.gov.au 21st August 2010)
This will help to ensure that levels of safeguards are established and put in place that dictates the grounds upon which patients are treated as well as ensuring that those who provide the service are able to cope with the related concerns in away that creates well ordered work practices.
As mentioned in the above prevention of abuse of mental health patients is a social concern. The stigma and stereotyping that has gone on in the past has only exacerbated and enhanced the typical stereotypes that exist in society for far too long.
The kind of mind sets that exist does not in any way help the situation at all. Failures to recognise the concern in its social context will do little to comfort those who seek and wait for the kind of change that will bring about work place practices that are void of those mind sets described in the above. In order for the above to have any affect it must be accepted that people suffer from mental illness in all quarters of our society. As stated previously it does not discriminate and crosses all cultural and social boundaries both socially and economically. In light of this statement the following will address in further detail the mechanisms where by change can be affected and by what means it can be achieved.
However it must first be acknowledged that social and professional change is not always an easy thing to achieve. It must also be acknowledged that our society is based on sets of principles and ideas that are fundamental to the way it functions and operates. In that context then it must be accepted that we all no matter what our disposition, are afforded rights of consideration and respect.
The kind that are and should be common place within a democratic society that operates and functions on principles of equity and equality for the masses, the kind of principles that entitles each and everyone one of us fair treatment. Based on the position then it should be no surprise that is addressing concerns of misuse of power and the subsequent abuse of power by health care professionals should and must be governed and managed by sets of procedures and practices that are consistent with these principles.
Often mistreatment in the work place can be linked too much broader social images and attitudes. That’s why work place practices must be supported by a much larger body of thought and action that spells out quite clearly that the misappropriation of power against those who have little control over their situation must be enforced. That is in the context of legislation and government and judicial management orders that establish clear and mandatory codes of practices. This in turn must be supported with mandatory and skills based training for professionals to better manage the risk of inappropriate behaviour and actions.
In examining the points raised in the above a case study found in Ethics and law for the health professions 3rd edition, by the authors Kerridge, Lowe and Stewart (2009) illustrates well, a number of important and fundamental concerns when considering issues of misuse of power and behaviours that are inappropriate. For example the authors in setting out the case study of a woman who was suffering from case of low self esteem talked about the type of power relations that are tipped in favour of the psychiatrist.
The authors in summary (describe the outcomes for the women in terms of misappropriate diagnosis and maltreatment with respect to medication and management of the illness. The Authors go on to state that Psychiatrists diagnose patients as having mental illness, institutionalise them against their wishes or free them from imprisonment, give them mind-altering substances and administer electro-convulsive therapy) (which means the application of electric current to specific areas to the head to produce a generalised seizure (Mental Health Act 1996 part 5). These power imbalances are the cause of many of the ethical issues in psychiatry”. Kerridge, et, al (2009, p. 499).
In short if a position had to be taken, as to the primary reason behind the misuse and abuse of power by health care professionals and this can be applied across the industry as a whole, then it would need to be one not to dissimilar to that stated by the authors in the above. That is, much of the concerns that the mentally ill face are based on power relations that are tipped in favour of the professional health care provider. The case study mentioned in the above is one that is all to typical of the kind of mind sets that pervade the profession. This is a prime example of those relations that exists and one which is representative in the way that it seeks to manage the cause and effect of the patients’ condition and in the process takes away not only their rights but also their dignity.
Finally, and in summing up, this paper has attempted to provide a discussion, although brief in detail points for consideration when it comes to issues of the misuse of power towards the mentally ill by some health care professionals. This brief discussion has attempted to highlight not only the need for the management of concerns in a much broader context but also in terms of the internal institutional organisation of treatment of patients. This paper offers for consideration a number of considered points to ponder as they relate to legal and ethical concerns of a other wise stigmatised and marginalised group. Vulnerable they are but not without rights. As a result of considering this topic in more detail, if there is one point of consideration that the author of this paper would like to share as a result of reflection, then it would be this. The responsibilities of health care professionals are enormous. They are the kind of responsibilities that impact profoundly on how patients are engaged and managed. Profoundly, in both the context of their much broader obligations and profoundly in the context of the social consequences of their actions as they relate to the health outcomes of the patient. And finally the above has reviewed the legal and ethical considerations that are fundamental to the practice of health professionals doing what they have been trained to do, engaging the patient in the kind of relationship that in turn helps to prevent the misuse of power by health care professionals.