Att navigera i gränslandet mellan individens valfrihet och statens ansvar: En fallstudie om hur kommunala verksamheter navigerar i situationer där personer med nedsatt beslutsförmåga avstår stödinsatser och skyddsåtgärder

Abstract

Ensuring the rights and well-being of individuals with impaired decision-making capacity presents a growing challenge for welfare states committed to both autonomy and protection. This thesis examines the ethical and legal dilemma when professionals within municipal services must balance respect for individuals’ choices and decision-making, even when those choices or decisions may lead to harm, with the state’s responsibility to protect vulnerable individuals. While international frameworks such as the UN Convention on the Rights of Persons with Disabilities (CRPD) emphasise autonomy and informed consent, a practical knowledge gap remains regarding how municipal services handle situations where service users decline support or protective interventions without meeting the legal criteria for coercion. The study is based on a qualitative case study of two Swedish municipalities and semi-structured interviews with social work and care services professionals. Using the Capability Approach as a theoretical framework, the analysis explores how practitioners interpret and support individuals’ capability for informed and independent decision-making. The results show that staff members frequently face significant uncertainty and must rely on relationship-building, empathetic communication, and professional discretion to navigate complex demands. The study concludes that freedom should be understood not merely as a formal right, but as a fundamental capability that requires structural support. These insights contribute to developing ethically sustainable and rights-based approaches within municipal care.