Justice : A Citizen’s Guide to the 21st Century – a review

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I’ve been spending a lot of time recently thinking about the effects of some of the actions I take, particularly placing some of my work within an ethical and philosophical framework.

Yesterday, I caught ‘Justice : A Citizen’s Guide to the 21st Century’ on BBC4.

It is an absolute joy of a programme and I’d say that it has helped me reframe some of the questions that come to me on a day to day basis.

Michael Sandal, a professor in political philosophy at Harvard University, presents some of the key tenets of some prominent philosophers, Bentham, Kant, Aristotle for example and puts some of the challenges that they presented in their writings but in a modern context.

Philosophy and ethics, as Sandal states at the beginning, does not take place in a lecture hall vacuum of reading dusty texts but it takes place every day with every decision we make.

These tenets of ethics and philosophy affect every decision I make both in a professional and personal basis. When I make decisions about how to spend my time and whether to spend longer at one visit to be later for another. To the decisions relating to compulsory admission to hospital and decisions about ‘best interests’ and where the line for capacity and individual freedoms are drawn – these are all decisions that come to me daily.

As Sandal takes us to different places to discuss some of the concepts that were expounded by these philosophers.

It led me to question myself (almost socratically!)

Do I make the right decisions? Are there right decisions?

Perhaps it is the system that needs to be changed?

How does the state serve the citizen, or perhaps it is the citizen that serves the state – and if so, is there any problem with that?

Does the state protect us? What do we offer to the state in response?

Has the nature of the ‘Social Contract’ Changed?

Mainly there is a question of individual and collective rights.

I love the ideas of creating a context to promote a better way of politics working that moves away from the individual but doesn’t dismiss the individual rights.

It is an excellent programme which I can’t recommend highly enough that left me massive room for reflection. It presents what can appear to be somewhat ethereal concepts as they have become and places them on a practical level. Not just on the nature of my work and my place as a ‘cog in the machine’  but the nature of modern politics and the ethical base and role of politicians.

We can’t rely on politicians to be the vanguard and determiners of what a society should be like but take a role as citizens in creating a world and society in which we want to live, taking action, if necessary to make changes.

I try not to lose the connection with my background as a philosophy graduate but this programme re-instilled and reinvigorated some of my love for debate about ethics (ethics was always one of my favourite courses).

It is part of a season on BBC 4 about ‘Justice’.  I didn’t catch the debate about Justice and the Big Society which was on over the weekend, but I hope to catch it on the iPlayer. There a lot of really interesting programmes coming up. As for this programme, I’d recommend it highly.

Preventing Project Prevention

This is a guest post by Stuart Sorensen.  Thank you Stuart!

Thank you CB for giving me this opportunity to post on your blog. It’s nice to have the chance to raise awareness of this organisation’s activities and to show how they might be stopped.

I first became aware of this organisation’s designs upon the UK last April and have been trying to raise awareness ever since.
http://stuartsorensen.wordpress.com/2010/04/10/project-prevention-eugenics-by-the-back-door/
The stated aim of Project Prevention is to prevent the birth of drug exposed children. The idea appears to be that no life at all is preferable to life gestated by an addict.

However, the ‘questions and answers’ section of Project Prevention’s website makes it clear that the prevention of social delinquency and violent crime are just as high on the charity’s agenda. It seems that discrimination based upon parental behaviour and denying the right to life of the socially disadvantaged is just as important to Harris.

It’s a voluntary scheme, began when Barbara Harris failed to get a bill passed in California making sterilisation compulsory and enforceable. It’s worth spending a moment reflecting upon just what such a law would mean.
It’s hard to see how it might be enforced without the aid of state officials quite literally kicking in the doors of hapless victims and dragging them off by force to the operating room.

It’s also worth considering the objections raised by the former drug using community (those ex addicts who have moved on with their lives). Many former addicts would have accepted almost any deal that provided them with the money to buy more drugs. Needless to say they represent the poorer end of the substance-using community. Those with money would hardly consider selling their future fertility for a trifling £200. Only the poorest would think this a reasonable deal – precisely the demographic Harris is interested in. But make no mistake, successful and wealthy people use drugs and alcohol too. But Project Prevention doesn’t seem to mind that.

There are many other reasons for this opposition.

Some of the objections include:
Philosophical arguments about anti-discrimination and the right to life;

Problems taking a controversial American service and parachuting it into UK where we have an effective welfare state and free access to alternative methods of birth control and reproductive health management;

Ethical issues concerning the fact that Project Prevention bribes people to consent to something not designed to be in their best interests but rather to serve the ideological, religious and economic ideals of others;

The inherent pessimism in offering a permanent ‘solution’ to a temporary problem;

The project’s historical focus upon predominantly black neighbourhoods and it’s link to eugenicist and ‘scientific racist’ Chris Brand;

The ethical problems associated with encouraging desperate people to make long term health decisions for financial reasons;

The short-sightedness of a project that aims to prevent life for those it deems fit only for a life of crime (read the Project Prevention website) but does little to tackle the real problem.

http://www.projectprevention.org/objectives/
“Objectives
The main objective of Project Prevention is to reduce the number of substance exposed births to zero. In doing so, Project Prevention seeks to reduce the burden of this social problem on taxpayers, trim down social worker caseloads, and alleviate from our clients the burden of having children that will potentially be taken away.”

http://www.projectprevention.org/the-sad-reality/
“The U.S. Department of Health and Human Services estimates that there were 740,000 substance exposed babies born in 1997. In Los Angeles, CA, 12,338 drug addicted babies were born between 1992 and 1996. This represents an average of eight addicted babies born everyday in one county. Some studies have shown that drug exposed children have trouble with language development and paying attention. Could this be why (according to a 3/7/99 L.A. Times article) special education costs in California have risen 35% in the last decade? Special education costs per child range from $3,000 to $125,000 per year depending on the severity of child’s learning disabilities and behavior problems.”

So why does this sectarian organisation, based as it is in eugenic racism and a philosophy that sacrifices vulnerable children to reduce tax seem so appealing to people in UK? One reason is simply that the amount of information presented by Project Prevention is so limited.

The name Chris Brand isn’t mentioned in the Project Prevention literature. Nor is the word ‘eugenics’. The fact that Chris Brand described the project as something that he hoped “will bring real advances for the eugenic cause”. is never reported on the website either.
http://www.bookrags.com/printfriendly/?p=wiki&u=Chris_Brand
Instead the reader is sucked into a superficial but initially quite compelling ‘black and white’ argument designed to use public sympathy for drug exposed babies as justification for their ‘prevention’. The website is disparaging about drug addicted mothers and dismissive of the prospects either for them or for their children.

The fact that UK midwives and other health professionals deal very effectively with these problems is ignored. Instead the website focuses upon problems such as ADHD and speculates that maternal addiction might be to blame for the rise in the US learning disabilities. The fact that their own statistics suggest otherwise is strangely absent from this argument.

Neither is there any discussion about the right to live a life with disability. Instead the Project appeals to the greed and self interest of the reader by talking about taxation instead. This ‘ready made solution’ approach that combines the carrot of tax savings (beyond Project Prevention’s control anyway) with the emotionally blackmailing stick of addicted babies is powerful. It tricks the reader into an uncomfortable proposition:
‘Support Project Prevention or the babies will suffer’
This is all the more bizarre when the aim of Project Prevention is the eugenic prevention of these babies ever existing.

Not surprisingly a number of professional groups objected. I interviewed Sara Stocks (then director of Project Prevention UK) last July and was given assurances that the UK model would be significantly different from the unethical process operated across the Atlantic. The interview was recorded and although the sound quality isn’t brilliant you can listen to it here:
http://stuartsorensen.wordpress.com/2010/07/09/interview-with-project-prevention-uk/
Since that time the UK directorate of Project Prevention has collapsed under the weight of ethical concerns and opposition from professional lobbyists in this country. However the fight continues as the American founder of Project Prevention, Barbara Harris has continued to target UK from her base across the Atlantic. Harris has been in the UK media regularly of late. It was she who accosted a mother and son in Possil Park, Glasgow with offers of a bribe if the woman (who was not an addict) undergo sterilisation. It was also Harris who handed over £200 cash to “John” from Leicester who had a vasectomy earlier this month.

It’s interesting, given that John could never have passed on any in-utero damage or addiction to any potential child how this meets the aim of preventing disability. However it’s not so hard to understand how it meets the eugenic argument so hotly denied by Harris and her supporters.

More disturbing in legal terms is the secrecy surrounding ‘John’s’ vasectomy. We now know that his real name is Alan and that the involvement of Project Prevention was kept hidden from professionals until after the procedure had been completed.
http://is.gd/gdLOM
This raises major issues around duty of care and safeguarding legislation which I have outlined in letters to front line workers here:
http://stuartsorensen.wordpress.com/2010/10/21/how-to-fight-project-prevention/
UK safeguarding legislation exists precisely to prevent this sort of abuse but we need people to report wrongdoing. There’s a longer explanation of the legal issues surrounding Project Prevention in UK here:
http://stuartsorensen.wordpress.com/2010/05/25/the-case-against-project-prevention/
There’s also an excellent open letter written by ‘Andrea’ to politicians and other ‘officials’ here:
http://stuartsorensen.wordpress.com/2010/10/22/excellent-set-of-questions-from-andrea-at-wired-in/
I urge you to distribute these letters to anyone you may know who might come into contact with Project Prevention and their activities.

You can also get regular updates about the project from my own blog by clicking on the Project Prevention category here:

http://stuartsorensen.wordpress.com/category/project-prevention-2/

Please speak out against this extremely cynical organisation and help us to kick it back over the Atlantic.

Risk, Capacity and Ethics

I know it gets a bit boring saying it but these last few weeks have been  busy. Ironically, bearing in mind what I have said about caseloads, the ramp-up in the disproportionate time available versus things to do ratio has been related to just one of my cases.

For obvious reasons, at this point, I can’t disclose too  many details but it will certainly be one of the ‘classic’ case studies that just about hits on all areas of practice including a hefty chunk of ‘ethical practice’ and what that may or may not mean.

This is a situation where I have worked from the basis of an assumption of capacity in regards to decisions being made, of course, in line with the context of the Mental Capacity Act. My judgement is not necessarily in line with other professionals and observers but ultimately, I am the ‘decision-maker’.

So, capacity is established. Even that is not clear-cut as I believe the individual has fluctuating capacity – as is not uncommon but the periods of lucidity allow the assumption to be made at those points.

And one of those ‘unwise’ decisions is being made. An unwise decision, we are told according to the Mental Capacity Act is central to our essence and choice as human beings with capacity and the making of an ‘unwise decision’ does not mean that someone does not have capacity.

So this is the perfectly acceptable and legally sound basis for the decision-making that I have taken.

We are given various examples of ‘unwise’ decisions on all the training we attend about the Mental Capacity Act. Often there is an element of humour in the training, you know, a man who might decide to spend his fortune on fast cars at the age of eighty rather than leave his money to his children and this is not a matter of capacity just because it is  not a ‘sensible’ decision. We all as an essence of our humanity take risks and make decisions that others might find ‘not very sensible’ but that doesn’t mean that we lack capacity.

It is a very important tenet.

The difficulty comes when firstly, there is not a necessarily clear-cut consensus that yes, this person is making a capacitous but unwise decision and secondly when there are risks attached.

Risk assessment is by it’s nature a tricky line to step. That’s the problem – if we knew all the facts, it would be simple.

I have been picking up lots of nervousness about this particular case because I think there was an expectation that the capacity assessment would go the other way – but the Act is clear about starting from an assumption of capacity.

I have spent an inordinate amount of non-work time worrying about the implications of the decisions being made. I went into work early one day after one of the ‘major’ decisions have been taken because this situation had been dwelling on my mind and I wanted to talk to someone about it.

I found my manager (who is always in early!) and ground her ear down a little about it. She was very good and patient with me as I explained my difficulties in separating the logical part of my brain where I am absolutely confident my practice is sound and I have acted in the way that is both in the best interests and respectful of the wishes of the service user – from the emotional part of my brain where I just want to be able to help more than we, as a service can offer or deliver in its current form.

I chuckled as I asked her, kind of jokingly, if she’d back me up in front of the GSCC if things didn’t go as we hope they will. She, of course, told me to stop being silly and that had I done anything more restrictive or authoritarian than she would have been truly upset with me. But in a way, that’s the ‘easy’ route – that’s the ‘safe’ route. When we talk about risk management and risk aversion, I can see the benefits and as a professional who does wield power to make decisions about peoples’ lives – that power unnerves me. I can see how easy it is to err on the side of caution.

A part of it is that I feel that although I can be clear that personally, I am taking the path which I am strong about, I feel that the service as a whole is not providing exactly what this person wants and needs and should have – because the needs are quite specialised and specific.

This should be exactly where ‘individual budgets’ can come into their own but the processes don’t always allow for people who are outside the ‘norm’. This is very far from a straightforward – ‘give a man a budget and let him plan’ that neatly fits the agenda of the individual budget. As I have discovered – although it isn’t really discovery as I knew this all along – it is hard to do anything quickly when you are wading through a swathe of largely unnecessary forms. It is hard to present some truly innovative systems and proposals when the system only permits choice to a certain degree.

As a practice assessor/teacher in the workplace, my last student often asked me about ‘ethical dilemmas’ as it was one of their competencies. I jokingly said that ethical dilemmas were a key part of the job as anything involving control had to be and when we cease seeing our power and influence as a part of that ‘ethics’ dichotomy, we take for granted the decisions we make and the power we have – we become dangerous practitioners.

We had a module on ‘ethics’ as a part of my Masters in Social Work but I also have a BA in Philosophy. I used to laugh about it and often do still. You know, the jokes about unemployed philosophy graduates and all that. To be honest, often they are fair.

But more than ever I am glad of the firm grounding I when I studied Philosophy as an undergraduate. Ethics – studied in far greater depth over the years of the initial degree, which seemed such a inately impractical course has bloomed into life.

Logic with it’s quasi-mathematical formulae has led me and directed my thinking in ways that I might not have been equipped to do otherwise.

I wonder, if, in retrospect, the first degree in Philosophy has aided my self-reflection and my skills as a social worker.

I remember when I applied for the Masters and the preference was for social sciences and I worried that people who had studied Social Policy would be better considered.

Now, I think Philosophy was the best grounding I could possibly have had. After all, doesn’t applied philosophy just about cover everything we do?