Abstracts
Résumé
La relation entre les intervenants en milieu de soins et leurs clients est souvent le lieu de profondes incompréhensions et de tensions entre les valeurs de liberté et de sécurité. Cela est particulièrement perceptible dans la relation avec les personnes souffrant de problèmes de santé mentale et d’abus de substances. Le but de cet article est de fournir des pistes de réflexion sur les enjeux éthiques qui se présentent à l’intérieur du programme de suivi intensif dans la communauté autour de la coercition et des conduites abusives de consommation. Les principes de base qui organisent le suivi intensif dans la communauté sont fondés sur les concepts éthiques d’égalité, de respect et de recherche commune de la vérité. Chaque personne est susceptible d’avoir la sagesse de sa propre vie et les habiletés pour gérer ses propres expériences. Il s’agit de créer un espace respectueux de réflexion, qui permet un dialogue entre les différentes perspectives, afin de concilier diverses préférences. Les interventions doivent être discutées avec le client, car celui-ci est au coeur de la prise de décision. Le cadre souple du suivi intensif, en regard de la complexité de la clientèle avec une double problématique, permet d’intervenir en respectant le rythme du client dans le processus de rétablissement et dans le changement de ses habitudes de vie.
Mots-clés :
- Coercition,
- éthique,
- abus de substance,
- suivi intensif dans la communauté,
- dialogue
Abstract
Relationships between healthcare providers and their clients are often fraught with profound misunderstandings as well as tensions between the values of freedom and security. This phenomenon is particularly noticeable in relationships with people suffering from mental health and substance abuse issues. The purpose of this article is to provide avenues for reflection on the ethical stakes that arise in the context of an assertive community treatment program focused on coercion and substance abuse. The basic principles of assertive community treatment are based on the ethical concepts of equality, respect, and a shared search for the truth. Each individual is believed to hold wisdom regarding his or her own life and the skills needed to manage his or her own experiences. The idea is to create a respectful space of reflection that allows for a dialogue between various perspectives, with a view to reconciling diverse preferences. All interventions must be discussed with clients, given that they are at the center of their own decision-making. In light of the complexity of a clientele exhibiting co-occurring severe mental illnesses, the flexible context of assertive community treatment offers a way to respect clients’ pace in terms of both recovery and the process of changing lifestyle habits.
Keywords:
- Coercion,
- ethics,
- substance abuse,
- assertive community treatment,
- dialogue
Resumen
La relación entre quienes intervienen en el medio de la salud y sus clientes está sujeta, a menudo, a profundas incomprensiones y tensiones entre los valores de libertad y seguridad. Esto es particularmente perceptible en la relación con las personas que sufren problemas de salud mental y de abuso de sustancias. El objetivo de este artículo es el de brindar pistas de reflexión sobre las cuestiones éticas que se presentan en el programa de seguimiento intensivo en la comunidad, en torno a la coerción y las conductas abusivas de consumo. Los principios básicos que organizan el seguimiento intensivo en la comunidad se fundan en los conceptos éticos de igualdad, respeto y búsqueda común de la verdad. Cada persona puede tener la sabiduría de su propia vida y las habilidades para gestionar sus propias experiencias. Se trata de crear un espacio respetuoso de reflexión, que permita un diálogo entre las diferentes perspectivas, a fin de conciliar diversas preferencias. Deben discutirse las intervenciones con el cliente, puesto que este está en el centro de la toma de decisión. El marco flexible del seguimiento intensivo, con respecto a una clientela con una doble problemática, permite intervenir respetando el ritmo del cliente en el proceso de restablecimiento y en el cambio de sus hábitos de vida.
Palabras clave:
- coerción,
- ética,
- abuso de sustancia,
- seguimiento intensivo en la comunidad,
- diálogo
Appendices
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