Introduction

In line with the aims of Part Three (see Figure 1.1), this chapter explores professional and interprofessional ethics from the perspective of professionals working within an Intellectual Disabilities (Learning Disabilities) team. Vignettes based on lived experiences of people with intellectual disabilities (ID) and the teams working with them have been used to illustrate the dilemmas faced by multidisciplinary teams. The authors draw upon medical ethics and moral ethics theory to frame their discussion.

Multidisciplinary and multi-agency working is well established in ID, though different professional backgrounds and cultures can lead to disagreement between practitioners and debate over the ethically correct approach to contentious situations. Examples from practice will be used to illustrate these concepts. The development of ID as a health speciality, recent legislative change and the resulting overarching obligation of ID workers to consider the impact of incapacity and vulnerability will also be described. Effective interprofessional and interagency working are integral to intellectual disabilities practice and must be utilised to promote optimal care. The authors will comment reflectively on current practice and suggest strategies for developing shared understanding.

The terminology used to describe people with arrested or incomplete cognitive development is varied and includes ID, learning disability and mental retardation. For consistency, the term ID will be used throughout this chapter.

Background to current practice

ID is defined as a condition of arrested or incomplete development of the mind, characterised by impairment of skills that contribute to the overall level of intelligence, that is cognitive, language, motor and social abilities. This skills deficit is manifested during the developmental period (World Health Organization, 1993). This intellectual impairment is consistent with having a measured intelligence quotient (IQ) below 70, and will typically mean that the person will need a degree of support to manage in society. People with ID are also more likely to experience various physical and mental health conditions; people with profound and multiple learning disabilities have been shown to be particularly vulnerable to the detrimental impact of a multiplicity of conditions on quality of life (Garrard et al, 2010).

In Scotland in 2011, 26,036 people were recognised by their local authority as having an ID, equating to around six in every 1,000 people. There were also 2,992 adults identified as being on the autistic spectrum, of whom 2,369 (79%) also had an ID (Scottish Consortium for Learning Disabilities, 2011).