Love Without Consent: Reclaiming Autonomy in the HealthCare Economy

For a while now I have been trying to pinpoint that feeling of feeling like a puppet to someone in which your arms and legs move to complete a task but it feels against your needs, will or expectations. For instance, when work over extends and crosses a personal boundary of understanding, or the experience is not valued appropriately, or respected, yet it is essential to doing a good job?

For instance one may make an agreement to provide help and support to someone under specific conditions; using qualified skills, experience and the intention to drive forward a directive. These agreements may include practical boundaries, goals and a vision. However those boundaries may be violated through a carelessness, a de-valuing of the importance of them, an ignorance around physical accountability and they may intentionally be exploited through the organisations 'policies', leaving large areas of emotional and financial accounting out of the equation. 

The healthcare industries, system of accounting for persons, are legally allowed to exploit or take advantage of persons more readily available as there are large parts of the healthcare industry that are made up of ‘volunteers’. The providers of care are driven by compassion and love, however they may easily be taken for granted, have their skill sets undervalued, there maybe an over look, around significant service providers needs and personal vocation. This then can take away a lot more energy than was origionally signed up for or compensated for. The emotional and physical accounting system may also be distorted by narratives not agreed to, on a baseline, by the frontline staff. A person may project from a future reality, without acknowledging the freedoms or needs of the present, they may also be unconsciously disabling a person from their survival needs, without taking care around this area due to not realising important aspects of value in working under certain stressful conditions. 

As of 2024, the voluntary sector in the UK is said to employ  approximately 978,000 people, representing about 3% of the UK workforce. Within this sector, social work is the largest employing sub sector, accounting for 39% of the voluntary sector workforce. Additionally, the NHS benefits from many charities and families who support various services, from patient companionship to administrative assistance. These volunteers enhance the capacity of health services and are considered essential.

Informal Caregiving by Families

Beyond formal volunteering, families provide substantial informal care. In 2023, there were approximately 19.5 million families in the UK.

While it is difficult for me to highlight precise percentages due to the overlapping roles of a genuine relationship with family care in which there is high levels of commitment, the informal nature of some caregiving can be essential and life giving, yet it can be detrimental to a service providers best interests. It's highly evident that both formal volunteers and family caregivers are integral to the UK's health and social care infrastructure. Their contributions, though sometimes undervalued, weave a tapestry for the system's sustainability and effectiveness.

In the quiet corridors of care institutions, a subtle yet profound dissonance often whispers through the night. Health Care givers, driven by compassion, find themselves navigating a landscape where their emotional and physical boundaries are routinely impacted. This phenomenon, where one's body and heart respond to external demands despite internal resistance, is not merely an occupational hazard; it is a systemic issue that echoes the complexities of consent and autonomy in service provision and in caregiving roles.

The Unseen Cost of Compassion

The healthcare industry, while noble in its mission, frequently leans on the goodwill of its workers, creating an extremely top heavy pyramid in respect to financial renumeration. Volunteers and lower-tier staff often operate under conditions that blur the lines between choice, duty and obligation. The expectation to provide unwavering emotional support, coupled with inadequate compensation and recognition, creates an environment which can be termed as "somatic compliance”; a state where individuals physically perform tasks that conflict with their personal will or well-being, the impact can disable a person financially, emotionally and on a physical level.

Understanding Somatic Compliance

Somatic compliance transcends mere physical action; it is the embodiment of actions misaligned with one's internal state. In caregiving, this manifests when individuals continue to offer care, therapeutic practice, consultation, despite emotional exhaustion or personal distress, often due to perceived duty or fear of reprisal. Over time, this dissonance can lead to burnout, emotional numbness, PTSD and a diminished sense of self; a silent erosion of personal agency and autonomy.

The Neurology of Will and Autonomy

From a neurological perspective, the continuous override of personal boundaries activates stress responses detrimental to both mental and physical health. The autonomic nervous system, responsible for regulating involuntary bodily functions, becomes dysregulated under chronic stress, leading to issues such as anxiety, depression, and somatic symptoms. This physiological toll underscores the necessity of honouring personal boundaries within caregiving roles and leads to fight or flight responses, creating very unstable working conditions.

Healing Through Conscious Practice

Addressing the challenges of somatic compliance requires a multifaceted approach:

• Recognition: Acknowledging the existence and impact of somatic compliance is the first step toward change.

• Education: Training programs that emphasise the importance of personal boundaries and self-care can empower caregivers to advocate for their well-being.

• Support Systems: Implementing structures that provide emotional and psychological support can mitigate the adverse effects of caregiving stress.

• Policy Reform: Institutional policies must evolve to ensure fair compensation, reasonable workloads, and respect for the autonomy of all care workers.

A Call to Reimagine Care

True care extends beyond patient outcomes; it encompasses the well-being of caregivers themselves. By fostering environments that respect and uphold the autonomy of service providers in the healthcare industries, we not only enhance their quality of life but also improve the overall efficacy and humanity of care services. Let us envision a care economy where love is given freely, not extracted; where consent is a cornerstone, not an afterthought; and where every act of care honors both the giver and the receiver, with transparency, understanding and healthy boundaries in respect to developing relationships with patients and staff.

Redefine "Voluntary" in Policy and Practice

• “Voluntary” often implies freely chosen, but in reality, people, especially women, low-income workers, and families, feel obligated due to moral pressure or systemic gaps.

• Advocating for a new legal definition that includes emotional labour and physical exertion, requiring disclosure of risks, time, reports and expectations in every role, including informed consent at regular intervals.

  
  

2. Embed Trauma-Informed Practice

• Train organisations (NHS, charities, care homes) in trauma-informed care, focusing on:

  • Autonomy and choice

  • Somatic boundaries

  • Consent in every interaction

• Emotional and physical check-ins should be routine and protected: not "self-care encouragement," but structural support with supervision.

  
  

3. Mandate Reflective Supervision

• Require all voluntary carers (and even family carers) to have access to monthly reflective supervision - a space to:

  • Decompress emotionally

  • Identify burnout or over-giving

  • Reassert physical/emotional boundaries

  • Ask them what direction they would like to take their growth and development, based on their own goals to enable a trauma-informed understanding.

    
    

4. Fair Recompense or Resource Exchange

• If labour is essential and recurrent, it should be either:

  • Compensated financially

  • Or offset with holistic tangible benefits (housing priority, time credit systems, pension points)

• This validates that the care offered is a form of labour with value and cost that does not compromise a right to live a full and expansive life.

  
  

5. Create Emotional and Physical Impact Statements

• Before starting, each voluntary care role should come with a Personal Impact Statement Template, asking:

  • How do you feel physically about this role?

  • Do you feel this reflects your will or are you compromising to meet others' needs?

  • Do you feel emotionally safe in this environment?

    
    

6. Develop a ‘Somatic Consent’ Model for Care

Inspired by body-based trauma therapy, introduce a "Somatic Consent in Care" framework that includes:

• Noticing body resistance before saying yes

• Understanding when “helping” is a nervous system override

• Teaching that empathy without boundaries becomes harm

  
  

7. Include Voices of Lived Experience

• Develop feedback loops where volunteers, carers, and families speak publicly or privately about their experiences of emotional overload, pressure, or burnout e.g., via Citizens’ Assemblies or NHS listening sessions.

• This helps design policies with heart, not just statistics.

Enabling those working with people in healthcare consultancy and care, to have a voice and consent to boundaries is essential in enabling a healthy culture that allows trauma informed practice to develop in a robust system that brings clarity, recognition and allows professional practice to be fully supported. There are many ways that written contracts can undermine staff, policies create a wonderful avenue of exploitation, physical and emotional accountability allows deficits to heard, and lessons learned at the expense of others to be fully compensated. If someone says to you - 'We learnt so many lessons through this situation'. Did you put yourself forward to volunteer as a teacher in this way? How would they like to compensate you? Promoting a development culture in which people are seen in their catalysts of power enables value to be met with reward and stability.

Amanda McGregor, insightforlife and Belovedlight, integrates creative consciousness and therapeutic practices to support personal development and healing.