Tag Archives: argument

Duty of care: A slug in a bottle

Donoghue vs StevensonIf there’s one thing that unites almost everyone concerned with health and social care services it’s the fear of being sued. Otherwise rational and courageous workers have been reduced to quivering wrecks at the mere suggestion of litigation or the slightest suggestion that they might have failed in or ‘neglected’ their duty of care.

Duty of care is such a preoccupation for workers that it crops up daily in conversation and in practice whenever we encounter ‘thorny’ issues relating to ‘health and safety’, ‘rights and responsibilities’, ‘freedom of choice’, ‘confidentiality’ and a host of other topics. What all of these conversations have in common is ‘duty of care’.

However not everyone who hears the term understands what it means or indeed where it comes from. This is a shame because as we all know knowledge is power and one way to know about something is to know a bit about its history and development.

Lord Atkin delivered a judgement in the House of Lords on August 26th 1932, thus ending a legal battle that had gone on for four years. The judgement became what is known in UK law as a ‘binding precedent’ because (with the exception of the new Supreme Court) no other UK court has the authority to overrule the principle that comes from it. This is the principle that most Duty of Care decisions are based upon.

What is this principle that was so important it still affects us today? We’ll get to that. First let me tell you the basic facts of the story.

May Donoghue was a shop worker in Paisley, near Glasgow who, one Saturday afternoon went with a friend to buy an ice cream float at Frankie Minghella’s café. As it turned out Mrs. Donoghue didn’t pay, her friend did – and this is significant.

Having finished most of her ice-cream float she discovered the partly decomposed carcass of a slug in the bottom of the bottle that had contained her drink. She was later treated for gastro-entiritis (presumably as a direct result of consuming some of the corpse).

Mrs. Donoghue’s next move was to sue the owner of the café. However the café owner, Mr. Minghella argued that his only duty of care was to the person who bought his goods and since Mrs. Donoghue had not paid herself there was no legal case to answer.

Not to be deterred Mrs. Donoghue turned her attention to Mr. David Stevenson whose company had manufactured and bottled the soft drink in question. The argument was that Mr. Stevenson had a duty of care to the people who used his products in the end – however far removed they may be from his own bottling and production plant.

Lord Atkin’s ruling was that Stevenson was responsible and stated in the ‘Obiter Dicta’ (legal jargon for ‘last words’ that explain the judgement) that we all have a legal responsibility not to injure our neighbour.

“You must take reasonable care to avoid acts or omissions which you can reasonably foresee would be likely to injure your neighbour.”

The definition of ‘neighbour’ he used was this:

“persons so closely and directly affected by my act that I ought reasonably to have them in contemplation as being so affected when I am directing my mind to the acts or omissions which are called in question.”

In other words we all have a legal duty, ‘a Duty of Care’ to consider the effects of our actions upon other people who may be affected. In health and social care this basic principle includes following the various rules and legal obligations that surround our work.

In practice it means that:

We all have a duty of care to the ultimate consumer

That’s the principle of this case: Donoghue v Stevenson 1932. However far removed we might be from the face to face ‘frontline’ of clinical practice we all have a duty of care to ensure that our practice is safe and reasonable.


Course design 9: Schema (build on what they know)

According to Wikipedia a schema can be described as…

  • An organized pattern of thought or behavior.
  • A structured cluster of pre-conceived ideas.
  • A mental structure that represents some aspect of the world.
  • A specific knowledge structure or cognitive representation of the self.
  • A mental framework centering on a specific theme that helps us to organize social information.
  • Structures that organize our knowledge and assumptions about something and are used for interpreting and processing information.


This is one of the reasons for the importance of themes and the sequential structure of topics that are introduced in a logical order throughout the training day. It helps participants to maintain a cohesive schema. But there’s more to it than that.

All of your training ‘victims’ will have their own schemata (worldviews) already. They bring them into training with them and good training acknowledges that.

If the materials you present appear to conflict with their pre-established worldview then you will have great difficulty in maintaining their interest, their engagement and your own credibility. So it’s important to start the ‘journey’ they will take through the training with what they already understand. To put it another way…

Meet them where they are

In the previous instalment I used the example of a deliberate self harm course for a reason. It’s because it provides us with an excellent illustration of how to use participants’ pre-existing schemata to gain engagement and then lead them on to new discoveries and more sophisticated understanding. Let me explain….

Many people believe that deliberate self harm is all about us. They think (because for years care professionals have told them) that deliberate self harm is all about attention seeking and manipulation. The reality is that this is not true but to begin with this blunt statement would meet signficant resistance that the trainer may never really overcome.

So before we can lead people to this realisation we need to do two things…

First we need to give the participants a reason to change their minds – they must make their own decision. As Rudyard Kipling once wrote

“A man convinced against his will

Is of the same opinion still”

Secondly we need to ‘soften the blow’ by incorporating as much of their pre-existing knowledge into the new belief system as we possibly can.

In deliberate self harm training I usually do this by exploring coping in general and by asking the group about their own coping skills. Once we have developed a long enough list of coping skills we highlight the ones that induce chemical changes in the central nervous system. At this point we have not directly mentioned self harm, just general coping skills.

In this way we tap into the participants’ existing schema about coping and then added a small piece of information (that doesn’t contradict their original view) which is that they are manipulating brain chemistry to feel better.

Only once they have clearly understood the chemical aspect of coping skills such as exercise, alcohol and substance use, arguing, making love, relaxing/meditating, comfort-eating etc do we make the point that physical trauma also stimulates endorphins in the central nervous system in exactly the same way.

We have begun with what they already understand about their own coping, added a piece of information that is non-threatening and then introduced the same information to demonstrate that deliberate self harm is just another version of what we all do.

This is working with the participants’ schemata. It also remains consistent with the general themes of the training…

  • Deliberate self harm is a coping strategy.
  • We’re all the same.
  • Care workers are not the focus of people’s problems – it’s not about us.

By taking the time to work with peoples’ schemata we can introduce some quite sophisticated concepts over the course of a day without difficulty. It isn’t uncommon for participants to report a completely changed point of view by the end of the day without having to overcome any significant resistance during the training. This lack of resistance is a sign that attention has been given to step by step development of their existing schemata rather than trying to go straight into what may be contentious, unfamiliar or otherwise uncomfortable for them.