Sunday, October 1, 2017

Human Rights Competency #2: Respects Individual Conscience

A major difference between healthcare and human rights values is in their attitude toward individual conscience.  The healthcare paradigm is the province of experts and expert knowledge.

In our society, experts tend to be in power roles.

Here is the essence of a power role:

Social Rule for Power Roles

If you have more education or prestige than me, you get to overwrite my judgement  

If  I protest, one of two things likely will happen:

1. I will lose
  • Most people will support and assist you 
  • They will ignore or coerce me

2. I will win the battle but lose the war  
  • To my face, people will give the appearance of letting me have my way
  • Behind my back, they will call me stupid or difficult
  • When I am present, they will give me the cold shoulder.

Substituted judgment thus becomes the order of the day. Even highly personal prerogatives - like personal vision, values, priorities and lifestyle preferences - may subjected to professional vetting. This is a common experience in healthcare settings, and especially in 'behavioral health.' The usual justification is "It's for your own good" or "We needed to keep you safe."

Let's think about that for a moment.

How does me experiencing...
  1. You callously override my deepest beliefs...
  2. You flagrantly disregard my gravest concerns...
  3. Everyone kiss up to the power role..
  4. A general tenor of rejection or indifference by everyone present, including my peers ...
  5. You as someone I must please upon penalty of judgment, pain or torture...
... promote the well being, growth or humanity of either of us....?

Another common justification is "We needed to keep others safe."

Let's think about that as well.

How does having others witness...
  1. A higher status person callously override a lower status person's deepest beliefs...
  2. A higher status person flagrantly disregard a lower status person's gravest concerns...
  3. Everyone kiss up to the higher status person...
  4. A pervasive tenor of rejection or indifference to someone in great need ...
  5. A lower status person being judged, hurt or tortured for disagreeing with someone of higher status...
...promote the well being, growth or humanity of any of us....?

Just as just as important, what does it teach all of us about:
  1. The importance of conscience vs. rote obedience to authority
  2. The value of thinking for oneself vs. robotic compliance
  3. Whether other people can be counted on when you need them
  4. Whether the power of love or the love of power rules this world
  5. When and how you can use power if you have it

And how does any of that make humanity safer, kinder or more conscientious for any of us...?

Broader (and even scarier) implications

Sad to say, the healthcare industry is not that much different than anywhere else in the industrialized world.   Unilateral top-down management is pretty much the go-to mode for ordering human affairs. When anything important needs to get done, the use and abuse of power roles is so ingrained in our culture that you almost never hear it questioned.  Parent-child, teacher-student, boss-employee and doctor-patient relationships are all prime examples.

In fact, right now you may be wondering, What's so wrong with that?

But think about it

We live in a world of big government, big money and multi-national corporations.  With few exceptions here, the management is hierarchical.  A single executive or CEO can bind the judgment of hundreds, thousands, possibly even a million employees.  It can change their life and that of the communities were they live. This can happen with a single decision - and in a single moment. The prerogative of one person can be that extensive.

To be sure, the CEO may be highly qualified and work hard.  They may be very devoted to the company's success.  But is that all that different from anyone else who works there: 

These days, pretty much every employee is expected to:
  1. Perform their job competently
  2. Work hard
  3. Be loyal to the company
  4. Make personal sacrifices for the collective good 

Everyone who works there is also:
  1. Investing their life and their energy into the business 
  2. Foregoing other options and life choices 
  3. Ceding valuable rights (like free speech, belief, reason, conscience, self-determination) to company managers 
  4. Relying on the company for their livelihood
  5. Hoping this will create a decent future for themselves and their families

Think for a moment about what that means for our collective future:
As a human race, we now have a social structure that allows those in a few key roles to overwrite the ...
  • lived experience
  • reasoning
  •  vision
  • values
  • conscience 
... of entire organizations and communities  - and control their livelihoods to boot!

Now think about this:
  •  Who, if anyone, are those select few are accountable to...? 
  • What values and motivations drive the decisions they are making...?
  • How likely is it that CEO decisions are being made in a 'spirit of brotherhood' for the people and communities affected...?
  • What happens to the conscience and morale of the average person under these circumstances...?
  • What happens to the social fabric when we institutionalize disregard for the average person's values and relevance in this way...?
  • How might the effects of widespread alienation from personal agency and conscience manifest in what we are currently calling 'mental illness' ...?

Can you hear the giant sucking sound...?

Can you see why it is important for mental health practitioners to work to heal - rather than ratify and perpetuate - this kind of social violation...?

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