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Title: Assisted self-harm in mental health care facilities : an ethically acceptable approach?
Author: Gutridge, Kerry
Awarding Body: University of Bristol
Current Institution: University of Bristol
Date of Award: 2012
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The aim of the thesis is to establish whether "assisted self-harm" is ethical or moral, when used in adult acute inpatient environments; in other words, whether it is consistent with how people should live their lives and treat others. "Assisted self-harm" refers to management strategies for self-harm which strive to reduce/limit, rather than stop, the behaviour. Strategies include offering advice on safer places to injure or allowing/providing sharp implements. In the project I used an "empirical ethics" approach, combining philosophical analysis with empirical studies to produce normative, not descriptive, conclusions. I conducted individual qualitative interviews with 5 patients and 20 inpatient or home intervention mental health professionals. Two focus groups were conducted: (I) with people from adult community services (n=4); and (2) with people from a specialist service for personality disorder (n=12). The interviews provided descriptive data about people's motivations, reasons and intentions when they self-injure, as well as predictive data about the possible consequences of allowing injury and participant-driven arguments for or against the approach. This data was used to complement theoretical analysis of the key concepts "autonomy", "responsibility" and "harm" and was integrated into my own arguments, to provide recommendations for action. Based on the combined analysis, I argue that "assisted self-harm" is justifiable in the shortterm as a means to reduce long-term harm, provided that five conditions are met. Thus, where the patient: is using self-injury primarily to manage distress; is injuring in a way which is associated with a low probability of physical damage (given the presence of appropriate support, such as advice on technique); possesses sufficient mental acuity after injury to engage with therapy; has an honest and open relationship with staff who are familiar with their history; and is capable of injuring in private, then "assisted self-harm" m.ay be an appropriate and effective approach.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available