to think that Human Rights has a lot to answer for in this obesity related death.

[meyesmyeyes]

A lot people are saying, Well why were people getting him that food? Why weren't they saying No? and why weren't the 'Carers' refusing to give him his takeaways etc.... OK, he would have sworn at them, but he couldn't get out of bed, so wouldn't have been able to harm them for not getting him his junk food.

the human rights act allows him to do what he wants if carers do not comply they are in the wrong and are liable to lose their jobs psychiatrists have to prove they do not have the capacity -- very few people come under this sadly

So surely, this poor man was failed miserably by a system that was supposed to help him?

People should have been in a position where they were able to say 'no' to him. But because of a flawed human rights system, this man has lost his life.

The 'if it was my child' argument doesn't hold anyway - because once your child turns 18, they get to make their own decisions. Even if your child turns 18 without capacity you do not get to choose what happens to them anymore - you can have a say, you can state your opinion, but the decision is out of your hands. And even for obese people lacking capacity something like restricting what they chose to eat would not be a decision that could be just made by one person, and it would be a decision that should be revisited. The right to make a choice - even 'bad choices' - is very strongly protected in law (as it should be).

That's nothing to do with the HRA either - it comes under the mental capacity act.

BeenWondering
We were referring to 'sectioning' of people with anorexia, in the context of enforced treatment/eating regime. So this is in a hospital/treatment centre, once the person's been assessed - nothing to do with s135 or s136. Or brief holding section or anything else. So how would someone with schizophrenia be on a different 'level' of section to somone with anorexia, if we're talking in the context of enforced treatment within a hopsital/treatment centre?

I did look at the Rethink page on it earlier, only being familiar with s135 & s136, but still none the wiser. All the 'sections' seem like they could be applied to someone with anorexia, schizophrenia, bipolar or whatever, in different circumstances.

Carers where I work deal with very similar scenarios. To even suggest other alternative foods would mean instant removal removal from that client.
Clients are able to remove carers from caring for them on a whim, there is no protection. So no choice for the carers.
This happens to a lesser degree a lot. An awful lot

Well tbh people should be able to remove carers! It's not a 'whim' if scared starts policing you or imposing their own values. Many people with disabilities now employ carers directly themselves using direct payments or personal budgets - they're the employer so of course they get to decide who they employ (under usual employment practices).

If an agency is commissioned by an LA, then changing agencies is more complicated, but of course will be done if the agency isn't meeting needs (& if there is an alternative).

Saintly, of course they should. I am referring to removing people for ridiculous reasons, that would not comply with relevant legislation.
For example wrong faith, too old, wrong marital status, wrong class, wrong family set up.

I kid you not.

What is interesting about this discussion so far is that it has not touched on funding or resources. When these arresting individual tragedies happen, they affect a lot of people emotionally (understandably), and those people cry 'Something must be done'. However, when it comes to paying for it, or making choices about resources, the majority of people (in recent years anyway) have cried 'No new taxes'.

We can't have it both ways. We can't simply call for efficiency savings or wage caps or reduced pensions and expect that the savings made will fund the kind of Scandinavian welfare provision that we'd all like to have. The kind of intensive intervention that some posters have called for would be very expensive to provide (and the man might still have refused it). So, hands up everyone who is willing to pay more tax to fund it? I am, but I think I'm in the minority. And for everyone else who would, I expect there would be 2 or 3 people who cried 'No, he's chosen to do this to himself, if there is extra money give it to cancer patients, or ill children'.

So, hands up everyone who is willing to pay more tax to fund it?

In theory, yes. (I say 'in theory' because I'm not convinced money is spent wisely in the provision of some services relating to healthcare. I think much more emphasis should be on awareness and prevention of certain diseases, and probably on interventions before a critical situation is reached.)

I'm all for democracy and freedom of choice, but I think it's pretty fucked up that in a society which makes it very difficult, and unlawful, for people with awful illnesses to choose to end their life with dignity (and difficult/unlawful for anybody assisting in such an act), the same society allows a person to eat themself to death and, for all intents and purposes, allows others to facilitate this. I know it's complex, but it doesn't feel right.

Poor OP She backtracked ages ago.

Hmmm. I can see both sides. It's obviously very necessary for some disabled people to have a kind of "personal assistant" to facilitate their day-to-day living.

But... I just can't see how I could do the job of a carer to someone with anti-social demands. Surely this isn't just the customer is paying so is always right situation. I could not operate like a robot and do whatever the client asked. As the client, one would surely have some sort of human relationship with the carer - otherwise they are merely a machine to do your bidding.

I love the idea in this thread that if it is a person who has a carer, we should exploit that situation to give them fewer personal choices than anyone else. That carers in general should "filter" the personal choices of the people they work for.

Quite horrific, really.

Brenda the carer is there to facilitate the life the client wants. Not educate them etc.

looknow - I do think there has to be a match for carers. When I advertise for carers for my son, I suggest they should like dogs, and be willing to get in a wetsuit and go in the sea, don a bathing costume and go swimming, or go on a ten mile tramp across the moors. Because that's the sort of activities my son wants to do.

I make it clear before employing anyone though. But if someone was employed who then decided they couldn't wear a swimsuit in public, or they were happy to walk but only on the flat and nowhere near any mud, we'd be a bit stuck.

Some of his carers have been interviewed on TV today.

As has a local takeaway owner who had a key to his house, in order to let themselves in and take the food to him in bed. So his carers couldn't have stopped that, if they'd wanted too.

The carers are not appointed to make personal decisions on behalf of the people that they care for. That is a horrendous idea.

Saintly, I am with you on that and agree. I think we are talking about different scenarios.

I work with very difficult people who make unreasonable demands that carers should be able to refuse, they can't always do that. Then one day the client decides, very unreasonably that that dislike one aspect of the carer that they don't like. Often this aspect is discriminatory and totally unrelated to the care and professionalism delivered but still they find themselves removed from that care provision.
Equal rights surely mean equal responsibilities towards those delivering care. I am talking here of those with no mental health issues entering into playing canes just because they can.

bangalanga
I love the idea in this thread that if it is a person who has a carer, we should exploit that situation to give them fewer personal choices than anyone else. That carers in general should "filter" the personal choices of the people they work for.

Quite horrific, really.

I don't know how it could be considered exploitative to try and steer an individual away from a path of self destruction and possibly death.

I agree that it wouldn't be appropriate for a carer to make such decisions - those decisions should be make elsewhere within the system. There are other examples of healthcare provision which is contingent upon an individual's pledges regarding their lifestyle behaviours - one example, off the top of my head, would be an alcohol related liver transplant, which ideally requires the recipient to abstain from alcohol for life. (Would you see that as interfering with a person's free choice?)

Out of interest, would you think it wrong to intervene if somebody was attempting to commit suicide?

Fascicle where in the system?! The law (mental capacity act) is very clearl, a person has a right to make an unwise decision if they have capacity.

fascicle There are other examples of healthcare provision which is contingent upon an individual's pledges regarding their lifestyle behaviours - one example, off the top of my head, would be an alcohol related liver transplant, which ideally requires the recipient to abstain from alcohol for life. (Would you see that as interfering with a person's free choice?)

A lot of this seems to relate to what is considered a mental disorder and what is not. For example, two people presenting with suicidal intent will get a different response depending on diagnosis. One may be sent on their way "It's their choice", the other may be hospitalised against their will.

Assessing whether someone has the capacity to make decisions for themselves is also really complex (I'm not even sure if I'm using the right words!) So, to pinch an example I read, someone held under section in a hospital has obviously has certain freedoms and choices taken away. However, you might ask them "would you like tea or coffee?" and actually, they do have the capacity to make that small decision! So where are the lines drawn? And who are they drawn by?

Addiction throws another spanner into the works. Once someone's addicted, where is the 'choice'? Something like being addicted to illegal drugs you could argue that the choice was made right at the beginning (if the person knew the substance was addictive). However, something like food, or even alcohol, that is deemed a normal part of life, can create an addiction that sneaks up on you.

Even with hard drugs, how does rehab work? Presumably someone going through cold turkey is going to be crying out for their drug after a day or so? So they make the decision to get off the drugs, then sort of hand themselves over to be locked up for a bit? Is there a voluntary relinquishing of freedom, or are they sectioned? Either way, at some point they've made a decision (to get off drugs) then need others to reinforce the decision when they inevitably can't due to the power of the addiction. Once enough time has passed (depending on substance? Or other factors?) the person obviously has to work really hard not to slip back, so we're back in 'personal choice' territory. Although if underlying issues have not been addressed even that isn't as simple as it sounds...

But it certainly seems as if there is some legal way to say "I'm making this decision now, but later I won't be able to stop myself, so need help". Even with mental illness, it's possible for someone to spot the signs they're going downhill and may need protecting 'from themselves' later down the line, and sort of hand themselves over... (in theory anyway, in reality services are so overstretched as to be 'reactive' only).

Looknow - sounds tricky & I'm surprised there are enough carers available to meet those sorts of demands tbh. It's hard enough to find people with the abilities to work with ds1 - I can't imagine getting awkward about people who have the skills!

"I'm making this decision now, but later I won't be able to stop myself, so need help"

Maybe there was space to do this within his care plan but he chose not to do it. In the same was that people can sign an agreement to get themselves voluntarily banned from betting shops.

At the heart of it I think these people at the very extremes of obesity almost always have some deep trauma in the past.

Any real evidence for this?

I think the bottom line for overweight/obese people is just that food tastes so good, and 200,000 years of evolution has programmed to seek it out. I think most animals devote an awful lot of time to just eating as much as they possibly can. As soon as food has become plentiful people (and animals for that matter) have started getting fat, this has been the case all over the world and across every culture as far as I know. I am very will to be corrected on this though if I'm wrong.

I am very willing to be corrected on this though if I'm wrong.

Klayden
Fascicle where in the system?! The law (mental capacity act) is very clearl, a person has a right to make an unwise decision if they have capacity.

Decisions must have been made within the NHS about the treatment and level of care required for this man. The NHS provided a team of carers to look after him. In other situations, unrelated to mental health and legislation about decision making, the NHS does effectively intervene in matters of free choice e.g. making some treatments contingent on patients following certain guidelines, or even denying some patients treatment because resources are limited. Another obvious example of the NHS setting conditions and imposing certain restrictions would be patients receiving treatment in a hospital setting. In addition to the many general rules that patients will be subject to in hospital, I'm presuming it would be very difficult for a patient to organise, and have help with, selecting and receiving frequent and daily fast food orders whilst being treated for obesity related conditions.

It is hard to believe that more could not have been done to deter this man from continuing to make decisions that led to his life ending, especially when there would have been a wider awareness of his choices, which he needed other people to facilitate.

It's interesting to hear a different perspective, but must correct the fallacy about carers being beholden to 'service users' every 'whim'.

I found it impossible to 'remove carers on a whim' when I had to have council provided carers (outsourced to agencies) before I got to employ my own.

My 'whims' were pathetic and selfish things which no one gave a shit about, like:

• not wanting to be shouted at and screamed at in my own home
• not wanting carers to force me to do things that made my health deteriorate dramatically for no reason beyond that's what every service user 'has to do'
• not wanting carers to steal cash, vouchers and even my childs clothes
• not wanting carers to force me to leave my 18 mth old on his own in a room out of hearing range as he was 'too much hassle' to have him in the bathroom with me
• not wanting to be abused and humiliated, not wanting a carer to point and laugh at my naked body, and refuse to give me a towel so I could cover myself up whilst they were having a good laugh at me.

My complaints were ignored, and I was told that I'd get the carers I was given and be grateful. And that if I complained they'd make my life worse.

It stopped when I became so ill from them forcing me to do things that I couldn't, that I collapsed, and lost the use of my legs, and they refused to help me. Left me alone with my toddler, in the dark, trying to pull myself by my finger nails across the floor to get to the door. But all they did was accuse me of being out and leaving a carer waiting in the rain. I wasn't out. I was very much in. On the floor. Needing help. But the manager who phoned (my home phone!) to accuse me of being out slammed the phone down on me and the carer left after swearing at me through the letter box, before I could get to the door to beg for help. They endangered me and my child by their disgusting attitude and I hope they burn in hell.

Even they couldn't lie convincingly about that incident and I was finally 'allowed' to swap carers. I am still not back to my health pre-abusive-carers, four years later.

So no, I dont feel particularly sorry that people are allowed to 'change carers on a whim'. I only wish i'd been able to indulge my unreasonable demands to be treated like a human not a dog.

Now i know carers are treated badly in general by their agencies, and by the councils who drive costs down at the expense of the whole profession. But that's a separate issue which shouldn't leave carers taking it out on the vulnerable people they care for.

As long as carers blame their 'service users' and not their working conditions or agencies, carers will continue to have a rubbish working life. And the people who have to depend on such terrible levels of 'care', will suffer, as they are vulnerable. And it's their lives that get effected, they don't get to go home and complain about it, they have to live it day after day. And be told they have to be grateful for the terrible way they are treated.

Btw, the people I employ now directly have good working conditions, pay and contracts. And they don't abuse me. All on the same money (in fact less) than the council spent on my 'care' via agencies.

A person has to consent to their treatment and care plan.
There are very few exceptions to that.
When a person is admitted to hospital they consent to all of that admission including eg not ordering in food but crucially if they object to that they can leave.
When a person is admitted to an alcohol detox generally they sign up to a behaviour contract at the outset but at all times they are still free to quit the programme and leave. You cannot be 'sectioned' for drug, alcohol or any other addiction.

The only times that a care giver can act without consent are where a person is detained under the Mental Health Act or where they are deemed to lack capacity under the Mental Capacity Act. There are checks and balances and safeguards at all times.

Why are alcoholism, drug addiction and over eating not mental disorders under the MHA? Just that society, parliament did not deem them so.

fascicle With respect, you are way off. Firstly, his care would have been most likely funded by social care. I am telling you that we legally cannot obstruct someone from making these choices. We cannot deny basic care to a person depending on their choices. It would be inhumane.

OP, is it just fat people eating too much that you have a problem with? Should carers refuse to enable their patients to do anything that's bad for them?

"No, I'm not putting you in your wheelchair, I know you'll wheel yourself outside for a cigarette."

"No, I'm not getting you a glass for your wine."

"I saw your shopping list but I swapped the butter for low fat spray and the red meat for tofu, I'm not enabling you to eat unhealthy things."