Paternalistic Interventions with the Gravely Disabled

Abstract

Interfering in the affairs of the gravely disabled has received attention in areas such as philosophy, theology, law, politics, and sociology. For such persons to be declared incompetent and have guardians appointed to care for them, a balancing is required of the right to personal freedom against the right to care. When consideration is given to the underlying principles of autonomy and beneficence, a case can be made for weak paternalistic interventions with persons of diminished capacity who are clearly endangered and in whom the conduct involved is substantially nonvoluntary. Examples are given of beneficial results occurring in persons with alcohol dependence or alcohol-related brain damage on whom a paternalistic intervention involving financial management was imposed with the aim of seeing that basic needs were met and that spending on alcohol was not excessive.

Money Management After Acquired Brain Dysfunction: The Validity of Neuropsychological Assessment.

“…Thus, their current problems may reflect these premorbid difficulties rather than resulting from their disability. Under these circumstances, the ethical principle of autonomy states that a person is free to perform an action even if it involves risk to the person and even if others consider it foolish (Spittle, 1992). If a clinician, court, or tribunal does not consider the possibility of premorbid money management problems, it is at risk of erroneously finding a person to lack competence when, in fact, the money management problems are not related to the disability.…”

“…Given the lack of money management measures suitable for an ABD population, we developed a new survey to elucidate problems with money management associated with ABD, guided by those problems reported clinically and in previous research (Crowe et al, 2003; McColl et al, 1999; Spittle, 1992). In creating the survey, we tried to avoid setting a standard for good or bad financial management, recognizing that there is no demonstrated formula for successful money management and that money management varies according to an individual's goals and values (Olson & Beard, 1985).…”

“…Different and additional complications in money management can occur for people with alcohol-related brain injury (ARBI; brain dysfunction as a direct result of chronic heavy alcohol use). Some people with ARBI continue to spend excessive amounts on alcohol, without leaving money for their basic needs for shelter, food, clothing, and medical care (Spittle, 1992). People with ABD also report difficulties with access to their money, in that they require assistance with transport (Ponsford et al, 1995) and they have difficulty with or avoid using new technologies such as automatic teller machines (ATMs) and automated telephone responding devices (Crowe, Mahony, O'Brien, & Jackson, 2003).…”