Dear researcher,
I was wondering whether people in Switzerland actually have the right to be neglected.
Is there also a right to be neglected in the context of care?
Thank you very much for your reply.
Autonomy
If a person is of legal age and knows what they are doing, I would grant them the right to self-neglect. This stance is not based on any codified legal norm; there is therefore no right to self-neglect in this formal sense. However, it can be derived from other principles. Most important of these is the right to self-determination and personal autonomy. This is protected by the Universal Declaration of Human Rights as well as by the Swiss Federal Constitution. In social work, it is a key principle of professional ethics: I cannot impose my support on anyone who does not want it.
Exception: Acute danger
Exceptions are possible if a person’s behaviour poses an acute danger to themselves or others. For example, I could prevent a person from committing suicide against their will if I have reason to believe that they may not actually want to do so, are acting on impulse, or are unable to assess what they are doing. However, if this person has given careful thought to their wish to die, is of sound mind and is not being influenced by anyone, then they have the right to take their own life. This is the basis of assisted dying legislation in Switzerland.
Care and coercion
The issue of neglect is somewhat more complicated, as it is a highly subjective concept: How long is a person allowed to go without showering, brushing their teeth, changing their clothes, eating an unhealthy diet, tidying and cleaning their room (if they have one), maintaining social contacts, getting high on alcohol, drugs or medication, perhaps even wet themselves, and not seek or accept help? In the past, coercion was applied much more readily in such cases; today, self-determination is held in very high regard. If, for example, a homeless person refuses to go to an emergency shelter and wants to sleep rough – and they know what they are doing, are not in a state of mental distress, and are not harassing or threatening others – nobody has the right to lock them up anywhere. In the past, this was possible.
Grey areas
However, there are still grey areas today: is an institution allowed to have a person with a learning disability, who cannot say what they want, put in the shower every morning, even though it is clear from their non-verbal behaviour that they do not want this? In my view, that is unethical.
Another example: in a soup kitchen, I won’t refuse to give people food simply because they are unwashed and don’t smell very nice. Of course, I can suggest that they have a shower again. However, if someone has wet themselves, I will, for hygiene reasons, ask that person to wash and change their clothes before eating.
Another example: If a person has taken an overdose of drugs, I must, of course, administer first aid to prevent them from dying. If they want to cut down on or stop their drug use, I’ll help them with that too. But if they simply want to take drugs and be left in peace, I have to respect that decision, even though they’re harming themselves in the process. Even if it might pain me to be unable to do anything.