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Derogation of “duty of care” in favour of “choice”?

Janet Gill (Specialist Dietician based at Warwickshire Dietetic Services, South Warwickshire Foundation Trust, Nuneaton, UK)
Qulsom Fazil (Lecturer in Disability Studies and Behavioural Science based at School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK)

The Journal of Adult Protection

ISSN: 1466-8203

Article publication date: 30 September 2013




Chronic health conditions such as obesity and type 2 diabetes are higher in individuals with learning disabilities and significantly affect both quality of life and longevity. Healthy eating is an important factor in preventing these chronic conditions. The study reported here explored the role paid carers played in promoting healthy eating and how they managed the daily dilemma of balancing residents’ right to make unhealthy food choices against carers’ “duty of care”.


Semi-structured interviews were undertaken with a purposive sample of six residential paid carers. Interviews were transcribed and then analysed using a thematic approach.


This small study highlights the challenges that staff face when balancing food choice against “duty of care”. It highlights that when working with less able residents, carers are motivated by “best interests”, to place boundaries and restrictions on food access and choice. It confirms previous studies that increased levels of choice for higher ability residents, often results in less healthy food choices. The study describes a lack of policy, guidance and specific training for paid carers which results in them using their personal subjective values as a basis for decision making.


Since the publication of “Valuing People” (Department of Health, 2001) the core principles of residential services changed direction towards independence and choice. This study expands our knowledge on how paid carers make sense of the everyday conflicts between choice and “duty of care” when residents continue to make unhealthy food choices affecting their physical health.



Gill, J. and Fazil, Q. (2013), "Derogation of “duty of care” in favour of “choice”?", The Journal of Adult Protection, Vol. 15 No. 5, pp. 258-270.



Emerald Group Publishing Limited

Copyright © 2013, Emerald Group Publishing Limited

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