Abstract for presentation at Global Social Work 2004

Brain Injury Rehabilitation has become an important field of Social Work Practice.Often working in interdisciplinary teams both in the sub acute and community areas social workers work with the client and his/her primary social network to assist in recovery and adjustment. A brain injury often results in impaired cognition. One challenge this brings to clients and others concerned in their welfare, is reduced mental capacity and a person's ability to make decisions. Reduced mental capacity becomes an issue when it is perceived that a client is at risk of injuring themselves or other people because of impaired decision making. In such circumstances "powerful others" involved in their welfare can intervene and override the client's dilemma between autonomy (self determination) and paternalism (duty of care).
Self determination exists as a human right recognised by the social work profession. Duty of care is a valuable ethical principle recognised by social workers but also has strong currency as a legal precept. Social Workers working within the field of brain injury have to navigate a difficult path with this issue with pressures to act paternalistically. At a microsystemic level this includes various client issues including an inability to live
independently to an increased tendency for violence and drug and alcohol dependency. At a mesosystemic level the implicit pressure of other team members to act conservatively.At a macrosystemic level the policies and resources that underpin the operation of a brain injury rehabilitation service. On the otherhand there is the right of the client to make their own decisions,there is a plethora of literature that highlights the efficacy of working with a client from their own perspective.Balancing these competing
demands in such an environment often involves the social worker working intensively from a Strengths Based Solution Focussed Perspective, in collaboration with family and other team members with a client centred, goal oriented focus.The following paper will highlight the competing demands of self-determination vs duty of care and how opportunities are created to balance this dilemma.