Case Example

The following case example demonstrates how the three approaches – rational/technical, moral/ethical and structural/rights-based – might each draw on different knowledge, utilise different skills and be informed by professional ethics and values. It is not intended that the analysis gives a comprehensive account of the relevant legislation. Here the emphasis is identifying the important contribution of each approach to securing a balanced overall response to the situation as described.

Lech and Maria

Lech Janowski has been referred to social services by his general practitioner with a request for 'services to support him with the stress of caring for his wife'. The doctor provided the following information.

Lech, now in his late 70s, came to the UK from Poland when he was 16. Later, on a trip back to Poland, he met and married Maria, who is 10 years younger, returning with her to live in England.  He had various manual jobs, and was finally made redundant in his late fifties. 

Maria’s employment history is not known. She has not been out of the house for many years and now remains in one room, with limited mobility - she moves by pulling herself from chair to bed, assisted by sticks. She is very overweight. The doctor considers she has a psychosomatic condition compounded by her many years of physical inactivity.  She had one admission to psychiatric hospital, 15 years ago, and was diagnosed as having a form of schizophrenia, for which she continues to take medication, given to her by Lech.

Lech undertakes all the household tasks and Maria's personal care. He is said to be depressed, and he is struggling to cope, with the result that the state of the house has rapidly deteriorated. He is accumulating massive debts at local shops. He claims his wife hits him with her sticks if he has been too long away from the house. The doctor believes that Lech is deeply unhappy, and may one day abandon his wife.

Their home is a small, privately rented, unmodernised terraced property, in an urban, ethnically diverse area. The immediate locality comprises run-down private housing, a mix of older long-term residents and more transient, younger people in flats and bedsits. Most people live in some degree of poverty.

The Janowskis have no children and are said to be isolated in their local community as a result of their reclusive existence. Lech's English is good, although he is not very talkative. Maria does not speak at all. It is unclear whether she understands English or not. All communication with her is through Lech, and her responses are usually non-verbal.