Drinking to poor health

Kingston-upon-Thames health and disabilities
team.

This week’s panel considers a case where a
disabled person demands that his carers assist him in his heavy
drinking.

Case
study

Situation – Martin Burke (not his real name)
is wheelchair-bound and unable physically to care for himself,
although he manages to live alone. He has extensive home care
support, including a live-in carer. He also has a personal
assistant while he works at a voluntary disability agency. He
drinks heavily.

Problem – Burke appears to his carers to be
alcoholic – although this condition has not been formally diagnosed
– and begins each day with a large glass of vodka and orange. He
drinks steadily through the day (mainly strong canned lager) and in
the evening prefers red wine and more vodka. He cannot buy or serve
himself a drink and has to ask the carers to do it for him. Burke
himself has said that he is so depressed with his life that drink
makes it more bearable. He has also said that he is very aware that
he is drinking himself to death and is now saying this is exactly
what he wants to do.

The local authority, which employs Burke’s
home care assistants, is instructing its workers not to buy or give
Burke any alcohol if he asks for it as it is clearly damaging his
health. Burke disputes this – saying it is his right to choose what
to do with his money. If he could buy the drink himself, he would.
But as he can’t, the authority is discriminating against his
disability.

Panel responses

Samantha Robinson
Martin Burke obviously has a serious alcohol issue. The
difficulty is that he does not seem to have any desire to stop
drinking and therefore does not have any real insight into the
effects that it is having on his life. The alcohol dependency seems
to be his way of coping with his depression. I think it is
important to attempt to discuss the situation with Burke when he is
sober. This is the only way to gain an accurate assessment of his
true views and wishes. A way of attempting to tackle the situation
would be in the first instance to offer Burke counselling, in order
to assist him with the depression, explore the reasons why he is
drinking and to see whether he can acknowledge the effect that this
is having on his life. This may motivate him to reduce his alcohol
intake. The consumption of alcohol will ultimately worsen his
depression even further. As a consequence his alcohol intake will
probably increase over time.

A referral could be made to the community drug
and alcohol team. They will not be able to assist Burke effectively
until he acknowledges the effect that his alcohol dependency is
having on his life and has a desire to stop drinking. Once he
reaches this stage then inpatient detoxification could be an
option, alongside long-term support or therapy, which is essential
if Burke is going to abstain from alcohol in the future.

It may be pertinent to alert his GP about his
current mental health needs and the potential deterioration in his
physical health. The GP may then refer to the psychiatrist or
arrange for an assessment of his general health needs, if
appropriate. However, this would probably require Burke’s
permission.

The alcohol dependency must affect other
aspects of Burke’s life. For instance, is he making an informed
choice to purchase alcohol, rather than paying his bills or buying
food? If so, another option, which could be explored with him, is
an appointeeship. This would assist Burke with managing his
finances, ensuring his bills are paid and so on, restricting the
amount of available income he has to purchase alcohol. However, the
local authority would need Burke’s permission to proceed with an
appointeeship. Burke may not agree to this.

Ruth Sadler
While Burke is making an informed choice to continue
drinking, there is a need for clear guidelines to be adopted in
order to ensure that he is not compromising the position of all the
people who are caring for him and working with him. Burke is
correct to state that it is his right to choose what to do with his
money.

However, he does not have the right to expect
the carers to assist him with drinking when this is potentially
damaging to his health. This is not something that they have to or
should be doing. Burke is effectively compromising their position
and in such a set of circumstances it is reasonable to argue that
the local authority would not be discriminating against him. There
are other options available to Burke that could be explored, if he
wanted to continue his drinking, which do not necessarily need to
involve the carers.

For instance he could consider a home delivery
shopping service – many large supermarkets now offer this service
and it should be easy enough to set up. Also, Burke may well have
other contacts, such as friends or an extended family network to
draw on.

Health and safety issues become a potential
concern if Burke is intoxicated, when the carers attempt to provide
him with personal assistance. Clear guidelines need to be in place
to ensure that the carers do not place themselves or Burke at risk
when providing him with assistance. Care should not be provided if
Burke is intoxicated.

This is a safeguard necessary to prevent
accidents from occurring. The voluntary disability agency that
Burke is employed at should also have similar guidelines in place.
It is not acceptable for Burke to be working while he is
intoxicated. This approach may or may not lead to a moderation in
his drinking habits.

Is Burke’s alcohol dependency affecting his
relationship with the carers? Are the carers being supported? This
is a very demanding situation for carers to cope with, particularly
the live-in carer, who will be spending the majority of time with
Burke. His current care package as well as the relationship with
his carers could be explored, although he may resent this
intrusion.

User view

Personal assistance at home should, ideally,
be non-judgmental and solely directed by the client. In practice,
it is always a process of negotiation between client and carer. All
parties must have their dignity and sensibilities taken into
account. What a dilemma. Burke feels that his home care assistants
should be there to enable him to conduct his life as independently
as possible; the local authority has a responsibility to make sure
that the risks to his safety are minimised; the assistants are
there to provide their client’s “arms and legs” but should not be
put into the invidious position of doing something that would
clearly harm Burke.

In many ways, Burke is trying to put himself
in the same position as Ms B, who went to court, demanding that she
be allowed to die by getting her ventilator switched off. However,
the situation isn’t identical, in that his helpers have to be more
active in contributing towards his death than the medical staff in
Ms B’s case. I can imagine that this would be tremendously
distressing. As a side note, if Burke died as a result of his
helpers supplying him drink, would they be entitled to sue the
local authority for post-traumatic stress?

I can sympathise with Burke’s point of view. I
am a smoker: if my assistants refused to light my cigarettes, I
wouldn’t be able to smoke. We all realise that this is a dangerous
habit, and might be the eventual cause of my death, but this is
seen as an acceptable lifestyle choice. Burke might say that he is
just speeding up this process. He has already connected his
drinking to his current feelings about his disability. His
implication is that, if he weren’t disabled, then he wouldn’t be
drinking heavily, and maybe this is one of the keys to unlock this
dilemma.

He is not and neither am I currently
predisposed to alter our behaviour, and nobody changes their habits
without some degree of motivation. Although he doesn’t see a way
out of his drinking at the moment, maybe Burke should be offered
counselling for his feelings of depression, so that he can at least
act on his perception of his disability and social situation.
Perhaps he could be invited to look at the possibilities of
changing either his situation or the way that he feels about it.
Maybe then he can find some motivation to fight the fierce desire
to drink so heavily, and then he can be offered the appropriate
help.

Simon Heng is chairperson of
Worcestershire Association of Service Users and is a wheelchair
user.