National policy in the UK surrounding the support of people with learning disabilities stresses the autonomy of people in receipt of support and the need for those who support them to maximise this. However, support workers also have a duty of care and can find these two policy objectives in conflict with each other. The researchers in this study set out to explore this potential conflict in relation to the support of people with Prader–Willi syndrome (PWS). Given the behaviours associated with PWS, the authors believed that this would clearly illustrate the potential tension between respect for autonomy and duty of care.

Using ethnographic methodology, the researchers carried out qualitative observations, semi-structured interviews and analysis of documents top look at the work of support workers in a residential group home.

They found that risk was central to care delivery at the home and that support workers often adhered to standardised risk management procedures. The provider organisation required support workers to promote independence. Many of the staff thought promoting the independence of service users was important. Some support workers deviated from standardised risk management procedures to allow service users a degree of independence as a way of managing the tensions between their differing duties

The authors conclude that there is clearly a tension between duty of care the recognition of autonomy at the level of service delivery in residential homes. Whilst the support workers in this study clearly attempted to manage this tension; the authors call for work at the level of provider organisations and national policy makers to help reconcile the duty of care with the duty to recognise service users’ autonomy.

Duty of care and autonomy: how support workers managed the tension between protecting service users from risk and promoting their independence in a specialist group home, Hawkins, R et al., in Journal of Intellectual Disability Research, 55: 873–884