Handling dilemmas of self-determination in ‘user-centred’ rehabilitation

Abstract

The least paternalistic steering includes making the dilemma explicit and offering the user the opportunity of sharing the responsibility for the handling of the situation. However, due to the complexity of the interactions no strategy can be found to either completely prevent the occurrence of dilemmatic situations, or definitely maintain the user's self-determination during dilemmatic situations. Paternalism may occasionally be a just way of enhancing future autonomy.

Individual plan in rehabilitation processes: a tool for flexible collaboration?

“…This role is incompatible with the idea of client participation (Karlsson 2007;Shulman 2008;Townsend and Polatajko 2007). The professional must have collaborative skills to be client centred.…”

“…The professionals generally have more power, resources, and capacities than their clients do. According to Karlsson (2007), some clients may even find it difficult to raise their voice in planning processes.…”

“…More recent studies (Karlsson 2007;Leung 2008) argue that clients have a right to be involved in the service planning. Leung (2008) addressed the service provider's challenge to be accountable to clients.…”

“…Leung (2008) addressed the service provider's challenge to be accountable to clients. Karlsson (2007) revealed the dilemma of self-determination as part of practising client participation. Therefore, professionals must collaborate with their clients to develop top-quality human services; this requirement for collaboration challenges the idea that professionals are experts and clients are the objects of their intervention.…”

Desarrollo de la autonomía del niño en la atención pediátrica: hacia un modelo ético

“…En cambio, el paternalismo liberal es la fuerza que favorecerá en gran medida una participación pediatra-niño mutua en la toma de decisiones, y maximizará la capacidad del niño para ser autónomo. 25 Pellegrino destaca que la relación pediatra-paciente se vincula con la idea de recuperar la completitud y la autonomía perdidas. 26 De hecho, el pediatra no solo deberá favorecer la recuperación sino también estimular el desarrollo de mayor autonomía, en especial porque las enfermedades limitan existencialmente la autonomía de los niños.…”