Ethical Lenses as an Antidote to Abuse and Restrictive Practices in Care
When the culture within a care setting turns sour, the risks to vulnerable individuals escalate dramatically. An environment where staff feel disempowered, undervalued, and operating under immense pressure without clear ethical guidance, fosters conditions where poor practice occurs. This can lead to abuse and excessive use of restrictive interventions, can take root. It is precisely here that a conscious and active application of ethical lenses becomes indispensable. It shifts the focus from mere compliance to the cultivation of a deeply ethical operational ethos.
The shadows of toxic environments, potential abuse, and an over-reliance on restrictive practices can, regrettably, loom over care settings. In health, education, and social care, confronting these issues is not just a professional duty, but a moral imperative. This blog explores how embedding ethical decision-making, guided by the frameworks of Clark (2015) and the participatory ethics described by Sinkkonen and Laulainen (2019), serves as a powerful antidote. This helps steer organisations like JL Academy to deliver training directed towards safer, more humane, and truly person-centred care.
Clark’s Eight Ethical Lenses: A Framework for Safeguarding and Empowerment
Within the Timian Programme, JL Academy uses an adapted version of Clark’s (2015) eight ethical perspectives. This offers a practical toolkit for dissecting workplace dilemmas and building safeguards against the development of toxic care environments. Let’s examine how each lens can help us address the risks of abuse and undue restriction:
- Fairness: Clark (2015, p. 6) posits that decisions should be acceptable to all, regardless of their position. In care, a commitment to fairness directly challenges environments where power imbalances might lead to abuse or where restrictive practices are applied inconsistently or disproportionately. It demands that any intervention is scrutinised for its equitable application, particularly for those who are least able to advocate for themselves. If a behaviour strategy feels unfair to the person receiving care, or to certain staff members, it signals a potential breeding ground for resentment and poor practice.
- Merit: This lens, focusing on “demonstrated performance, skill and effort” (Clark, 2015, p. 6), might seem less immediately relevant. However, in a care context, it encourages recognition of an individual’s intrinsic worth and their efforts towards positive change, rather than a deficit-based model that can lead to labelling and a sense of hopelessness. This can be a precursor to overly restrictive measures. It also speaks to valuing staff for their skillful, ethical practice, rather than, their compliance with potentially outdated or overly punitive systems.
- Markets: While “voluntary market exchanges” (Clark, 2015, p. 6) might seem a corporate concept, its application here is about ensuring that the ‘exchange’ in the care relationship is positive and empowering for the individual. A toxic environment often features coercive control. This lens instead prompts: is the individual genuinely benefiting? Are their choices and preferences respected, thereby reducing the frustration that can lead to challenging behaviour and, subsequently, restrictive responses?
- Democracy: The principle that “No one should be subject to a regime in which they have no say” (Clark, 2015, p. 6) is a direct challenge to authoritarian care models where abuse and restrictive practices can thrive unchecked. Embedding democratic principles means actively involving individuals in their care plans, listening to their voice (and the voices of their advocates), and ensuring they have genuine input into decisions affecting them. This co-production of care inherently reduces the likelihood of imposed, restrictive measures (Department of Health, 2014).
- Well-being: Prioritising actions that “promote the health, happiness and fulfilment of persons” (Clark, 2015, p. 6) is fundamental to combating toxic care environments. Abuse and excessive restriction are antithetical to well-being. This lens compels services to ask whether their interventions are genuinely enhancing quality of life or merely controlling behaviour for the convenience of the system. Positive Behaviour Support (PBS), with its focus on improving well-being to reduce challenging behaviour, exemplifies this lens in action (Gore et al., 2013).
- Rights and Duties: Clark (2015, p. 6) reminds us that “Everyone has rights…and everyone has duties not to violate others’ rights”. This is the bedrock of safe care. A culture that minimises abuse and restrictive practices is one where the human rights of individuals (as enshrined in legislation like the Human Rights Act 1998) are paramount. Staff must be acutely aware of these rights and their duty to uphold them, ensuring any restriction is lawful, proportionate, and an absolute last resort.
- Character: The call to “develop the best ethical character for our roles” (Clark, 2015, p. 6) is vital. In a non-toxic environment, staff are supported to cultivate virtues such as compassion, patience, integrity, and courage – the courage to challenge poor practice. Where these characteristics are absent, and expediency or cynicism prevail, the risk of abuse and over-restriction increases. Ethical character development is a continuous process, essential for those in positions of trust.
- Handing Down (Legacy): The responsibility to pass on our “stewardship…undamaged” (Clark, 2015, p. 6) has profound implications. A care service that allows abuse or relies heavily on restrictive practices is creating a damaging legacy for the individuals it supports and for the sector itself. This lens urges us to build services that are not only safe and ethical now but contribute to a future where such negative outcomes are unthinkable.
The Collective Shield: Employees as Ethical Guardians
Sinkkonen and Laulainen (2019) powerfully assert the “unnoticed role of employees in ethical leadership”. This insight is crucial when tackling toxic environments. A top-down approach to ethics is insufficient; a genuine culture of safety and respect is built and maintained by everyone.
When employees are empowered through ethical understanding:
- Early Warning Systems Emerge: Staff who recognise the subtle signs of a deteriorating ethical climate or questionable practices are more likely to raise concerns before serious incidents, including abuse, occur (Sinkkonen and Laulainen, 2019). They act as the conscience of the organisation.
- Restrictive Practices are Challenged: An ethically aware workforce will question the necessity and proportionality of restrictive interventions, advocating for less intrusive alternatives.
- Supportive Peer Cultures Develop: Colleagues can support each other in navigating complex ethical dilemmas. This fosters a culture of openness rather than one of fear or silence that can enable abuse.
- Positive Practices are Championed: Employees become proactive agents in identifying and promoting person-centred, rights-respecting ways of working. This actively pushes back against any drift towards institutionalised or controlling approaches.
Forging Healthier Environments: Ethical Lenses as a Solution
The conscious and consistent application of these ethical lenses provides a roadmap for transforming potentially toxic care environments. Instead, turning them into places of genuine safety and growth. This approach directly tackles the roots of abuse and the overuse of restrictive practices by:
- Prioritising Individual Rights and Dignity: Placing the person, their well-being, and their human rights at the absolute centre of all decision-making.
- Promoting Transparency and Accountability: Ensuring that decisions about care and behaviour are made openly, can be scrutinised, and are justifiable against clear ethical principles.
- Empowering Voices: Actively seeking and valuing the input of individuals receiving care, their families, and staff at all levels.
- Fostering a Learning Culture: Encouraging reflection, open discussion about ethical challenges, and a commitment to continuous improvement, rather than a blame culture that can drive issues underground.
- Reducing Power Imbalances: Actively working to share power and control, moving away from models of care that are overly reliant on authority and compliance.
Conclusion: Building a Bulwark Against Harm
The challenge of preventing abuse and minimising restrictive practices in care settings is ongoing and demands unwavering commitment. By adopting frameworks like Clark’s (2015) eight ethical lenses and by nurturing the ethical leadership capacity of every employee, as advocated by Sinkkonen and Laulainen (2019), organisations can do more than just react to problems. They can proactively build a bulwark against the development of toxic environments. For JL Academy and all care providers, embracing these ethical tools is not merely best practice; it is the very essence of providing care that is safe, dignified, and truly supportive, ensuring a positive legacy for all.
James Hourihan BScEcon, MScEcon, MIoD, FRSA
Director JL Academy
Lead Senior Trainer Timian Learning and Development
References
Clark, S.J.A. (2015) Ethical decision Making: Eight perspectives on workplace dilemmas. London: CIPD Publishing.
Department of Health (2014) Positive and Proactive Care: reducing the need for restrictive interventions. London: Department of Health.
Gore, N.J., McGill, P., Toogood, S., Allen, D., Hughes, J.C., Baker, P., Hastings, R.P., Noone, S.J. and Denne, L.D. (2013) ‘Definition and scope for positive behavioural support’. International Journal of Positive Behavioural Support, 3(2), pp. 14-23.
Human Rights Act 1998, c. 42. Available at: https://www.legislation.gov.uk/ukpga/1998/42/contents .
Sinkkonen, M. and Laulainen, S. (2019) ‘Unnoticed role of employees in ethical leadership’. In: Kivivirta, V., Haho, P., Kivistö, M. and Laulainen, S. (eds.) The Management of Wicked Problems in Health and Social Care. Abingdon: Routledge, pp. 103-118.
