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An ethical dilemma in the learning disability services: too much money

St George's Hospital Medical School, London SW17 0RE

Jeanette Smith, Senior Registrar

Fromeside Clinic, Blackberry Hill, Bristol BS16 1ED

Gwen Adshead, Lecturer

Department of Forensic Psychiatry, Institute of Psychiatry, De Crespigny Park, London SE5 8AF

Learning disability services care for the needs of patients whose autonomy of thought and action is impaired by processes that often cannot be reversed. Their autonomy may also be limited by external influences such as carers' attitudes, both positive and negative. Others may therefore find themselves making decisions for such patients. The case presented in this paper illustrates how these factors can condemn a wealthy woman to a life of relative poverty, lacking in pleasures she could so easily afford, because she lacks competence in some areas of decision making. A possible solution is proposed.