Calm Down, Dear – and Why I Won’t

DAVOS/SWITZERLAND, 29JAN10 - David Cameron, Le...

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This isn’t really a social work specific lesson although it helps, it’s something that comes in handy in all professions.

You give respect, you receive respect. Sometimes it can be a bit more complex and sometimes you work with people from whom you can never be expected to get that respect back from – because of underlying attitudes or because of personalities but it doesn’t matter too much – water off the back and you continue to treat those whom you come into contact with with respect.

It doesn’t hurt and you have to have a bit of a thick skin.

There are many of these reciprocal ‘lessons’. Never ask someone to do something you wouldn’t do yourself is one that draws me back to my work, pre-qualification, as a care assistant. Don’t place someone in a care home you wouldn’t be happy to place your parent/child in. That can be more problematic because the supply and demand are not equivalent and sometimes geography limits the choice of residential care settings but I do think it is the best point to start from at the very least.

Provide services that you would want for yourself or your (insert close family/friend) would want. It’s fairly basic stuff.

So I think it indicates some of my discomfort about Cameron’s ‘calm down, dear’ moment in the House of Commons yesterday but more broadly, the level of banter and conviviality in Parliament that seems to replicate an  poor debating society for under 16s in a private school.

Sexist? Probably but did we ever think he was anything but? Intentionally so? No, I don’t think so. It’s the kind of talk and ‘rebuttal’ that comes naturally.

Disrespectful? Absolutely. It was a put down intended to diminish the speaker to whom it was addressed. That is more of my objection. Whether the person he was talking to was male or female, it is the kind of patronising tosh I don’t want to hear from a Prime Minister, although  I do think there is an agenda to diminish the sexist aspect and write off women who may be offended as ‘not being able to take a joke’ which  even further demeans those who might be offended by his comments or worse, use the feminist label to somehow make itself equivalent to having ‘no sense of humour’.

Honestly, if that is the level of humour that I should be chortling about, I’m very happy to be labelled as just ‘not getting it’ in favour of being a very proud feminist.

And how would you react if your manager said that to you? Well, not very positively. I know I wouldn’t.

Perhaps it is the ‘cut and thrust’ of the House of Commons? Lame response. As one of the people who doesn’t necessarily ‘enjoy’ the adversarial and frankly, childish response of our politicians waving and cheering like sheep in a  herd, I find it hard to understand the appeal of this rambunctiousness.  Oh, it’s tradition? Well, change it.

It is an indication that behaviour in the House of Commons follows a clear path from their schooldays. It is an attitude that automatically appeals to a certain type, and yes, a certain ‘class’ of person who feels comfortable in an environment where respect is a far distant imagination.

It is a work environment that encourages pieces like this in the Daily Telegraph. Seriously. Oh, what? I was supposed to find this ignorant and childish ‘blog’ by a major ‘quality’ newspaper which puts a little red ring around the breasts of a female MP and asks readers to ‘guess whose boobs these are?’ funny? Smacks of harassment to me. It actually sickens me.

Yes, sure, say I have ‘no sense of humour’ if that is your recourse but what kind of society condones this as humour? Not one I feel comfortable in and is ‘having a sense of humour’ so important that it can bypass respect, well, I’m happy to lack one.

Cameron talks of jokes and throw-away remarks but what he and the Daily Telegraph display is a lack of respect that he has probably never been party to by virtue of his position. The view of George Osborne laughing heartily at David Cameron’s intensely patronising ‘joke’ makes me realise how detached these politicians are from the reality of life in the UK at the moment.

We get the politicians we deserve though. That’s the tragedy. I just think we can do a whole lot better than these who seem to make a mockery of the political class of which they are members.

Capacity and Surgery

There is a case reported in the Telegraph today which I found interesting in relation to my work with the Mental Capacity Act – a generally very positive piece of legislation that has affected so many aspects of the way we work.

It is interesting partly because of the rarity of public judgements under the Mental Capacity Act (2005) so anything that comes up tends to be jumped on by practitioners as there is still a lot of vagueness that could do with some  legal clarification.

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The case talks about a 55 year old woman with learning disabilities who suffers from cancer. She is afraid of hospitals and has consistently refused hospital check ups and treatment due to this fear. Initially she agreed to surgery however her fear of hospitals and needles led her to miss appointments and refuse ongoing treatment.  Sir Nicholas Wall, the President of the Family Division agreed with the application by surgeons to operate in his role as presiding over the Court of Protection.

It seems to have been established that the patient did not have the understanding of the impact of her refusal to access treatment and therefore the process of assessing capacity and the judgement that she lacked capacity to make a formal consent were clearly established.

The decision to sedate her in order to admit her to hospital and to carry out what will amount to major surgery without consent is obviously so drastic that the bounds of the Mental Capacity Act were being tested and quite rightly the case was brought directly to the Court of Protection to judge.

It is a balancing act that should be subject to external scrutiny beyond medical professionals necessarily and obviously not being party to all the details, it can be easy to draw conclusions.

From an academic and professional point of view, it is interesting in the way that the Court of Protection  has been used to make a judgement relating to health and welfare, rather than strictly financial matters as had been the case prior to the new legislation. The discussion about ethics and the morality of forcing surgery on someone who lacks capacity to consent is also healthy in the sense that although the decision has been made to go ahead with the surgery, the discussion allows the consideration of her position and human rights along the process rather than simply allowing a dramatic decision to be made on ‘common law’ principles.

Sir Nicholas stated that he released the judgement to assist with other decisions that might be made in hospital up and down the country. I suspect that when there is a need to sedate someone and remove them to hospital, it would still be necessary to go to the Court of Protection for clarification but it allows us to see what some of the thinking behind the decisions would be.

There are, of course, implications that run through A&E departments constantly. There is a difference too, between planned surgery and an action taken in an emergency to prevent the loss of life. Perhaps the real story to take with us is that if we have firm ideas about our wishes for treatment or the lack of it, an advance directive is the safest way to go.