I have selected two examples from experience relating to ‘best interest’. They are perhaps at the more extreme end of the spectrum, but shining a spotlight on the far points sometimes reveal a truth in the centre.
When I was a student social worker, I worked with a couple in their eighties who had been married for over sixty years. They had no other living family members, and they lived alone in a large Victorian house in which the layout had become increasingly problematic due to their ambulatory difficulties. I became involved as he has fallen and broken his hip and had to be hospitalised, and she was not in a position, even with high level support, to remain living at home on her own during his post-operative recovery period. The plan: he recover in hospital, she receive a period of residential care, and meantime we consider together how their housing situation might be improved, perhaps by adaption, perhaps by moving to somewhere more suitable.
I was able to arrange the urgent residential care for her, fortuitously very near to her home. This she was very positive about as she had no desire to be any great distance from her familiar locale. She professed herself very pleased with the room in the unit, settling-in very quickly.
Meantime, I visited her husband in hospital, who was making a slow but incremental recovery, and who was looking forward to either returning home in due course, or, recognising the difficulties with their present home, a possible alternative.
It was at this point that matters became far more problematic.
She, Elsie we will call her, kept prevaricating over the residential unit’s attempts to arrange times for her to be taken to visit her husband John (I shall call him). So the unit asked me to visit and discuss it with her, which I did. After some preliminaries, I brought up the issue of arranging a visit to see John, to which she replied in a very steely voice, ‘I hate him, I never want to see him again, and I want to live here now.’
I will not detail the attempts we made to work with her on this issue, other than to say that both I and one of care workers with whom she had formed a very good relationship made every effort to explore the issue with her. She steadfastly refused to discuss it with either of us, nor would she meet the specialist counsellor I offered. At no point would she enunciate why she had made this decision.
I had to impart this news to John, who I can but report was highly distressed and presented as mystified in the extreme. He said he had no understanding whatsoever of why Elsie would be feeling this way, and believed them to have been happy together for over sixty years.
Every attempt to address and understand the dynamics of the situation failed. We could identify no history or information from any other source that might provide some answers, Elsie would not say and John had no explanation. Nor, I will add for the purpose of clarity and completeness, was there any evidence, or even the slightest indication, that Elsie was suffering from any form of physiological or psychological illness or impairment – be it those associated with aging or not – that might affect her thinking or judgement.
We made every effort to help and support John through this situation, but it saddens me greatly to report that he deteriorated very quickly and died. There was ostensibly no physiological, post-operative reason for this. He died, in my view, of loss – of a broken heart.
Elise lived for many more years in the unit, often stating her great happiness at living there, was greatly liked, and developed many friendships. She died there peacefully of old age having never disclosed her reasons for not wanting to see John again.
So whose best interests were served? Elsie’s: yes, regardless of the absence of explanation, one has to say that her subsequent years demonstrated that they were. But John’s: no, they were not, beyond any debate.
Was the social work and service provision correct? Yes, I believe so. But do I still feel extremely discomforted and in some peripheral sense responsible for John: yes.
Over twenty five years later can I suggest some way in which we could have effectively addressed and met his best interests? No, I cannot.
I worked with the recently turned fifteen year old Sally (as I will call her) first within a child protection investigation, and then as her allocated social worker. She was referred by her GP having disclosed she was pregnant by a middle aged family member with whom she had been living following the death of her mother from cancer some years earlier.
A joint investigation was undertaken. The man was initially arrested, however, for technical legal reasons I will not needlessly detail here, he was released and returned to the home address, neither accepting nor denying that he had been engaged in a sexual relationship with Sally.
Sally was a very articulate, direct, and strong viewed young person: and I do not mean that in any negative sense whatsoever. Her position was very clearly that she loved the man, was very pleased that she was pregnant, and wanted to carry on living with him. She had agreed to a brief period of foster care during the initial stages of the investigation, but was now adamant that she wanted to return home and be with him. She would have no truck whatsoever with the legal / moral / ethical aspects of the situation. She did not agree with any of those social rules and expectations, and she felt she should be allowed to live her life the way she wanted to. Unless that was agreed and facilitated, she would just return there of her own accord straight away, she made very clear.
After a considerable amount of discussion, she very reluctantly agreed to remain in foster care for a few days longer, having acknowledged that whilst I understood her position and did not want to disrespect her views, I was not able to agree (and I explained why), and I asked that we have some breathing space to discuss the situation together in more detail over the next few days. Unfortunately, that agreement did not hold, as the following morning she took herself back to the house.
I will summarise subsequent events by reporting that we then had to use the court process in order to ensure that she did leave the household and return to foster care, although there were many difficulties along the way. It would of course have been far preferable had he left the household, but for various reasons, that was not possible: he would neither agree to it voluntarily, and the legal processes of the time were not viable in the specific circumstances.After a great deal of direct work with Sally, she did in the end agree to a move to extended family members who were unfortunately in another county, as one would prefer not to move young people great distances, but none the less it was a safe, secure, place for her to be.
She had the baby, was very well supported by her family and was an excellent mum. She later returned to school and did very well. And right through until my very last visit, she never agreed with me. It was always her position that had she been ‘allowed to’ she would have lived with the man, but there was no point in fighting us any more as we were ‘too powerful’. Do I think that was in any way an affected position, far easier to say than really mean once she had actually moved on to a different setting. No, actually I don’t. You would have to have known her to appreciate my interpretation, but I am very clear that she absolutely meant it.
And whose best interests were served here? I say hers and the baby’s were. And I say it for exactly those legal / moral / ethical reasons I believed and enunciated then, which she so strongly disagreed with. And not just for those reasons, as we all know that teenagers can change their world view and appreciation and interpretation of events and meanings as they get older – the operative word there being ‘can’: it does not always happen, it is not a given. Does she feel the same three decades on? Did she in the end return to him when she was an adult? I do not know.
Would I undertake exactly the same social work practice again could I return in time? Yes, unequivocally. Even though it was effectively oppressive, legally preventing her from living with him? Yes, again unequivocally. I and the court had to make a professional-legal judgement about her and the unborn child’s best interest, and sometimes such processes are required to protect people, whether they themselves accept that they are ‘vulnerable’ or not. That process has to exist in a civilised society, and we have to ensure that it is a fair, balanced, and as safe as possible. It is not perfect, but I stand by its necessity.
Best interest is a deeply challenging concept for social work. It can be legally defined, and yet have far broader moral, ethical, and philosophical components. The definitions can change over time, and have. There are aspects to it which some might term ‘universal truths’ (which is fine as long as one happens to agree with the supposed universality of that truth), and yet one can come across endless situations where the individual circumstances do not fit the law, or the ethics, or the supposed universality. One person’s expressed or perceived best interests may be in total conflict with another person, or be quite out of kilter with prevailing social mores and norms.
And somewhere within this extremely complex set of factors, in the real world, the individual beliefs, ethos, and philosophy of the individual social worker will be in play, no matter how objective we seek to be – we are human, and we cannot get away from it. Somewhere, within the dynamics, what we think is in a person’s best interest will be shaping events: to deny that is, in my view, naïve. And that is a huge responsibility. But it is also I suspect something to do with why we choose to undertake social work. It is not because we think we are gods who can decide what is in people’s best interests; it is because we care so much about what is.
Nick Berbiers (@NickBerbiers) is a Social Care Interim Manager and Consultant at Neist Point Limited.
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Thanks Nick this writing really got to the heart of the complexities involved.
Interesting article. In cases like the older couple I sometimes find it useful to wonder if the decision-maker (in this case the wife) would have the right to decide this if professionals weren’t involved. In this case yes she would and so the best interests decision is to respect her right to choose like any other citizen.
Trouble is the idea that her husband has the right to lose the love of his life like any othet citizen isn’t quite so cosy. That’s the problem, of course with having the option to be paternalistic – many decisions cannot fail to result in trouble for someone.
Cheers,
Stuart