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THE other side of the Welfare Coin


templelady
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hee hee yeah, something like that.

In classes we talk about this stuff all the time. One prof said "learn to work the system for your clients"

Again better to get forgiveness later than permission now.

It doesn't work and there isn't much hope for improvement anytime soon.

Oh yeah, I forgot. She was unhappy about my not showing proof of a savings bond that Kelly has. I answered in the affirmative on that part of the form and stated the amount, as I do every year. But this year they need proof.

I don't have it, her grandfather purchased it for her when she was born and I've never even seen it.

Sigh, it's considered income, doesn't matter that I don't have access to it, doesn't matter that it's in the name of a minor child, they want to see it, 'send a copy please'.

lol so it goes.

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It is often a rob Peter to pay Paul thing. If they hired more workers to check out applicants/recipients, the money is still being spent. Probably more.

The best and most effective programs are those that require a return. As has been brought up, WPA was a great program. It built this nation's highway system, many of the schools, bridges, public buildings etc.

Is it slavery? NO NO NO NO NO NO!!!!! How does one get slavery out of people being paid to work????? And government benefits work out to be far more than minimum wage jobs with no benefits.

What I don't get is the complaint that there aren't enough workers in the system. Every time I ever had to ask for public assistance, I volunteered to help them out. Duh! If for every worker that says there isn't enough help that worker were allowed to assign tasks to recipients, then there'd be enough help. Ya know?

Can you imagine what would happen if those companies that hire illegal immigrants were required to instead hire public assistance recipients?

I have always, always, always been an advocate of putting people to work who are able to work.

Why?

Self-esteem, resume building, networking, cost efficiency, etc.

It just plain makes sense to me.

Even if someone is able to work only an hour at a time, that's an hour of help. Ya know?

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Can you just imagine what it would do if when people applied for public assistance they were first handed a skills checkoff list and second be informed that their benefits would be equivalent to hours worked at minimum wage?

And what about day care and transportation? Uh...have a daycare center at the public assistance offices...then hire applicants/recipients to staff it. Those applicants/recipients with vehicles would be required to transport x number of applicants/recipients without vehicles.

Gawd. Somebody wound me up...

What about clothes? What about hygiene?

Partner with thrift shops, churches, etc. Partner with the Y. Do something besides make excuses as to why these things can't be done.

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I don't know CW but you have some great points for certain.

And on another note but same subject one thing about these baby factories we have is why did it take so many years for the system to limit how many "I don't know who the father is" baby makers? That was like encouraging these women to suck the system dry! Slothful thinking takes very little encouragement to aid in it prospering.

It amazes me that we can see these solutions yet the air must get real cloudy in those offices where they make policies in.

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CW said: I knew a family in exactly the situations described (actually, several, but I know first-hand the situation in this one family...not just rumors around the 'hood). They got turned in...by me.

This family is now 'camping' in their home.

I couldn't believe that's all that was done!

It turned out that the husband (he works a full time job and is the only income in the household) had for many years refused to pay bills for 'luxuries' such as utilities, clothes, medicines and foods needed to meet medically required dietary needs. Because of the husband's income, the wife could not get any assistance whatsoever. Her health declined to the point of near death, but she had brought herself around...with no help whatsoever...to where she could walk without aid and had lost over 100 lbs. But that just angered the husband. When the wife ended up in the hospital twice in one month, she finally asked for help.

Although she had applied for Social Security three times, she had not followed through with the required paperwork and was therefore denied. The most recent denial was 2 months ago. The last time she was in the hospital, she was assigned a case worker. Since then she has been moving more and more towards independence...which includes the $650/mo she may get from Social Security. (Social Security Disability benefits are based solely upon the person's earned income throughout their lifetime. SSI benefits are based upon the current income of the home. If she stays in her husband's home, she will not be eligible for SSI. Even if she lives alone, SSI would supplement SSD only up to $850/mo. She's going to be in the lap of luxury.)

In the meantime, because she was not being physically abused and because of her health issues, she was not accepted at battered woman's shelters. She got desperate enough to stay in homeless shelters, but her health deteriorated quickly...to the point that she can no longer walk more than a few feet (because of damage done to knees, hips and feet while walking the streets during her time in homeless shelters...it is a requirement for adults without children to leave shelters between 7am and 5pm), she is still healing from diabetic sores that covered her body (her average blood sugar levels were 400-600+ during her time in homeless shelters due to absolute lack of access to any food besides donuts and coffee during the day and pasta heavy meals at night, stress (which always has raised her blood sugar levels at least 100 points), exposure and lack of ability to keep herself clean during the day), and she is now facing kidney failure.

I knew the possibility that my turning in this family would send this woman over the edge health-wise...but she needed intervention. That was my thinking, anyways. At least now she's on the radar screen, so to speak. Maybe it was a good thing, maybe it was pointless. Only time will tell. I do know that if she wasn't 'truly' disabled before, she is now...by all accounts...including professionals...so maybe sending her over the edge health-wise was the best thing for her."

I have some questions - I'm confused.

So you’re saying you turned these people in for what?

And after you turned them in was there an investigation and they were declared ineligible for any assistance? Are you saying that or that there was no investigation, that they people just had to stop using their neighbor’s electricity so now have no electricity at all?

You said you couldn’t believe that’s all that was done. What was the that which was done? I’m trying to follow along here.

You’re saying you thought you would help cause an intervention for this woman and now today she’s facing kidney failure as a result of your phone call?

If she had a home why did she have to spend evenings in a shelter and days not in the shelter?

If she’s got that severe diabetes, why in the world would she eat donuts and coffee during the day and pasta heavy meals at night?

I’m really lost at the part about it exposure and lack of ability to keep herself clean during the day – why wouldn’t an adult be able to keep themselves clean during the day?

And how would maybe sending her over the edge health-wise be the best thing for her?

So what part about this was good and how do you feel now about your plan and the way it ended up?

If you had it to do over again would you turn them in?

Since she had already brought herself back from near death with no help whatsoever, has she recovered yet from this latest assault – or is she still facing kidney failure?

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I have some questions - I'm confused.

So you’re saying you turned these people in for what?

Everything I could think of.

And after you turned them in was there an investigation and they were declared ineligible for any assistance?
Yes.
Are you saying that or that there was no investigation, that they people just had to stop using their neighbor’s electricity so now have no electricity at all?

There was (and may still be) an investigation (see above). How it turned out is a legal situation that is not something the public is privy to.

You said you couldn’t believe that’s all that was done. What was the that which was done? I’m trying to follow along here.
From where I stand in this situation, I could not believe that the woman was not helped.
You’re saying you thought you would help cause an intervention for this woman and now today she’s facing kidney failure as a result of your phone call?

If she had a home why did she have to spend evenings in a shelter and days not in the shelter?

If she’s got that severe diabetes, why in the world would she eat donuts and coffee during the day and pasta heavy meals at night?

Not as a result of my call, but as a result of actions taken or not taken to 'assist' her. I was quite detailed in my post, so maybe you will find your answers by reading it again.

I’m really lost at the part about it exposure and lack of ability to keep herself clean during the day – why wouldn’t an adult be able to keep themselves clean during the day?
Bow, think about this. She was out on the streets and unable to walk very far.
And how would maybe sending her over the edge health-wise be the best thing for her?

I put in an emoticon to indicate that being a tongue-in-cheek remark.

So what part about this was good and how do you feel now about your plan and the way it ended up?
None of it appears to have been good. I wish that instead of trusting that the system would step in, I would have been more helpful as a friend.
If you had it to do over again would you turn them in?

No.

Since she had already brought herself back from near death with no help whatsoever, has she recovered yet from this latest assault – or is she still facing kidney failure?

She has not recovered.

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Shelters, liker any other institution, are subject to the law. ANY shelter which failed to exercise due diligence in dealing with a woman this ill would find themselves shut down, fined and facing not only civil but criminal charges both as an entity and the individuals involved.

A shelter on finding themselves housing a woman with this level of illness would NOT be making her eat doughnuts, pasta, and walk the streets. They would be on the phone to local area resources to find her more suitable housing, have her hospitalized in the interim to make sure her blood sugars etc were at acceptable levels and feeding her foods that were acceptable.

Clearly CW, the wool has been pulled over your eyes--

This part of this persons story is a fabrication.

THE only exception to it being a fabrication would be if this woman DELIBERATELY withheld the information that she is ill, Then that would be on HER shoulders.

Secondly, a person whose health is so bad that they are facing death CANNOT be denied help

IT may mean that guardianship is appointed to handle money so that the funds are appropriately used

It may mean that a guardianship of the person is declared that in life and death situations can override the persons wishes and have suitable care provided

It may lead to a declaration of incompetency on one or several levels if it is clear that the person is either physically , or psychologically incapable or uunwillling to make sound health and life decisions

In short from the facts you have provided with one of two scenarios is in play

A--this person if not outright fabricating the story is definitely slanting or leaving large holes in the truth

B- the story is true for the most part except the severity of the illness is being severely exaggerated both in the telling to you and in the persons daily life as she continues to try and garner sympathy and milk the system

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Shelters, liker any other institution, are subject to the law. ANY shelter which failed to exercise due diligence in dealing with a woman this ill would find themselves shut down, fined and facing not only civil but criminal charges both as an entity and the individuals involved.

Please find the applicable laws for Kansas and Missouri and post that information here. It would help this woman tremendously and I would be glad to pass the information on to her.

A shelter on finding themselves housing a woman with this level of illness would NOT be making her eat doughnuts, pasta, and walk the streets.
Shelters are not obligated to provide for special dietary needs. Again, please post the pertinent laws and I will pass on the information.
They would be on the phone to local area resources to find her more suitable housing, have her hospitalized in the interim to make sure her blood sugars etc were at acceptable levels and feeding her foods that were acceptable.

She was sent to the shelter from the hospital...by hospital social workers and her case manager...who are the resources the shelter would turn to. Again, find the pertinent laws and I will pass on the information.

Clearly CW, the wool has been pulled over your eyes--

This part of this persons story is a fabrication.

In your mind. Your knowledge is limited.
THE only exception to it being a fabrication would be if this woman DELIBERATELY withheld the information that she is ill, Then that would be on HER shoulders.

As I said, she was placed in the shelter by social workers and her case worker.

Secondly, a person whose health is so bad that they are facing death CANNOT be denied help[/qutoe]I don't know what world you're living in, but in the real world, people facing imminent death can and are routinely denied assistance.
IT may mean that guardianship is appointed to handle money so that the funds are appropriately used

What funds? The woman has no money, no assistance, no income.

It may mean that a guardianship of the person is declared that in life and death situations can override the persons wishes and have suitable care provided

It may lead to a declaration of incompetency on one or several levels if it is clear that the person is either physically , or psychologically incapable or uunwillling to make sound health and life decisions

This was part of what I was hoping for by turning her situation in to the authorities. The response? Bitter laughter and pointing to all the changes in the laws that keep people from being institutionalized for longer than the obligatory 72 hours.
In short from the facts you have provided with one of two scenarios is in play

A--this person if not outright fabricating the story is definitely slanting or leaving large holes in the truth

B- the story is true for the most part except the severity of the illness is being severely exaggerated both in the telling to you and in the persons daily life as she continues to try and garner sympathy and milk the system

Templelady, I go back to what I've said before: In your mind. Your knowledge is limited.

Milk the system? Garner sympathy?

She gets nothing from the system. How is she milking it? She is on her 4th application for SSD. She isn't even trying for herself. Her caseworker is pushing her.

Sympathy? From whom? You? People here at GSC?

:jump:

If anything, if she were to read GSC, she would find that people would want to find fault, place blame, mock, ridicule, call her names, say she is lying and gossip in open forums about personal details of her life than be sympathetic to her.

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Understand I am not talking about everyone in society

I am specifically talking about those members of Society who expect some form of Welfare to assist in their care, housing, and food.

CW post does bring up some interesting points

What do we do about the person who either because of emotional, physical or psychological problems is unable or unwilling to make sound decisions about their life.

I'm not talking about being eccentric here, I am talking about a pattern of decisions that are potentially life threatening.

The chronic alcoholic

the chronic drug user

the diabetic who refuses to diet, eat properly or take their medications

the person with High blood pressure

and any number of other diseases that if not treated appropriately spell death

DO we as a society have a mandate that says "if we are to support you with our tax dollars YOU MUST comply with sound medical practice Vis-a-vis your disease"

And if they refuse,at what point does the state step in and declare them incompetent and appoint guardians to see that they do comply

Or is there a point where we say--you have made the choice --and turn our backs and walk away.

I have a tremendous problem with this last one--But I also am a believer in the idea if my taxes are supporting you you need to meet me half way.

So is the solution a form of group home where the chronically needy who are chronically ill are compelled to live lifestyles that are not injurious

But doesn't that go against our very belief system in this country?

SO what do we do with the person with a life threatening illness who uses said illness to garner sympathy, support and welfare monies --uses it to the point of acting in ways that further exacerbate that illness with disregard to the potential life ending results---all to further their lifestyle choice of no responsibility for themselves???

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Poppycock.

Guardianship can be appointed by a hospital's administration at any time, and at no cost to the patient or member of the community. Guardianship does not mean legal council always. It can mean anyone, such as the hospital's president or board of trustees, who would make decisions for the patient if a relative or partner was not available to do so.

Shelters are not obligated to provide to the specific diet needs HOWEVER a food bank most certainly could do this. Many churches have access to food banks. The Care Management department of any hospital would also have community connections to food banks.

If a patient was discharged to a shelter it would be because (a) she no longer needed skilled medical care and did not qualify for a skilled bed facility (i.e. a nursing home or other similar assisted living facility and (b) she had no friends, no family, and no other place to go where she would be safe. A patient with a life-threatening illness would not be discharged to a shelter. Shelters are available to provide safe housing for people with no alternatives. They have staff to work with the people to help them secure a place to live, even its another shelter that is more suitable to their needs and specialized in teaching people life-skills. If you feel you were discharged against your will or discharged to an unsafe shelter, then you should most certainly contact the care management department of the hospital you were discharged from to discuss this with them.

If your illness is life-threatening and you are not getting your medical needs met - WHICH INCLUDES diet needs - then you should (a) contact the care management of the hospital from which you were discharged to report this and if a reasonable alternative is not offered then you should (b) contact your physician's office and if you don't get resolve there © you should go to your local emergency room to report your conditions and seek treatment.

I am sympathetic to the fact that there's few options and a lot of waiting for results. However, unless you are ready to be the squeaky wheel, then you can expect to get no where fast and to stay in the rut you are in. You have to bug, pester, and be a pain in the @$$ sometimes to get into these programs. These programs, such as your hospital, emergency room, care management department, local case workers, town welfare departments, shelters, food banks, etc. all get their funding based on the services they provide. Whether they are paid from local tax payers' money or from Federal dollars, they are all obligated to help you. Every state also has an Omsbudsmen program - if you contact the Department of Health and Human Services in your state, they can give you the phone number.

If you mean business, go squeak - get your needs met. Otherwise... why complain about it if you don't want help? I don't get that..

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Please find the applicable laws for Kansas and Missouri and post that information here. It would help this woman tremendously and I would be glad to pass the information on to her.
This is not a situation that is different in Missouri and Kansas than anywhere else. any shelter-knowing of a persons illness who demanded that they eat foods that were injurious to them or perform tasks that could harm them would be legally liable--anywhere in this country
She was sent to the shelter from the hospital...by hospital social workers and her case manager

If she was sent to the shelter By these individual s you can be sure that said shelter was notified that she was severely diabetic. Second if the solution was to send her to the shelter --perhaps, just perhaps-- the determination had been made that this person was in large part responsible for her situation and was attempting to milk the system and they felt the shelter would be a wake up call as to her behaviors.

In your mind. Your knowledge is limited.
My knowledge is limited in many areas, however, having worked with the homeless and near homeless off and on for the last 15 years not as limited as you suppose.
What funds? The woman has no money, no assistance, no income

From the situation you yourself outlined you turned her in because you felt she was committing fraud of some kind. The result of fraud is that the system demands some guarantee that they won't be defrauded again hence guardianship's

She gets nothing from the system. How is she milking it? She is on her 4th application for SSD. She isn't even trying for herself. Her caseworker is pushing

There you have my point in a nutshell SHE ISN"T EVEN TRYING FOR HERSELF

That pretty well sums up her life from what you have posted

And for the record I have tremendous sympathy for the downtrodden, the exhausted, and those persons who have come to the end of their tether for whatever reason. I would be hard pressed not to having been there myself. I got out, I got out with help from friends, Agencies, and God. I got out because I was willing to do the things necessary to change my life for myself.

A person who is a diabetic

and eats foods she knows are bad for her

stays with a man who is exacerbating the problem

only applies for available assistance at the insistence of others

IS NOT I repeat IS NOT willing to help herself

And If this next makes me a hard--- I really don't care

No matter what your background no matter how rotten your life, no matter what your childhood was like--unless you are severely mentally impaired YOU Are responsible for the ultimate outcome of your life.

Are there going to be hard times? YUP

Are there going to be times where just plain GUTS is required to take a scary step into the unknown for the chance at something better? OH YEAH.

Are there going to be HARD decisions necessary? WITHOUT A DOUBT.

But we are people not coral stuck in one spot tied to the whimsy of the tides.

Insanity is performing the same actions and expecting different results

Edited by templelady
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And for the record I have tremendous sympathy for the downtrodden, the exhausted, and those persons who have come to the end of their tether for whatever reason. I would be hard pressed not to having been there myself. I got out, I got out with help from friends, Agencies, and God. I got out because I was willing to do the things necessary to change my life for myself.

A person who is a diabetic

and eats foods she knows are bad for her

stays with a man who is exacerbating the problem

only applies for available assistance at the insistence of others

IS NOT I repeat IS NOT willing to help herself

I believe this is exactly what is happening with this woman. She really doesn't want SSD. She doesn't want to leave her husband. She doesn't want anybody to do anything for her except to leave her alone.

I felt sorry for her once upon a time.

Now I know that she has most likely made an active choice to give up.

That is her right. Her husband supports her with his income for which he works. She refuses any assistance from her church, food banks, and such. Nobody but her husband is bearing her burden. Other than her husband, nobody else has any right to say anything about her choices.

I was just very specific.

Do you need me to also make the phone calls?

I think it's all a moot point now, Chas. Her experiences in the shelters were a few months ago. She has been living with her husband since then. As I said above, I think this is the way she wants things to go...surrounded by her family.

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Well that takes a load off my mind

If she is in the hands of professionals then they will know if any programs that are there to meet her needs.

Of course it should go without saying that the woman in question needs to be willing to honestly and forthrightly comply with any and all suggestions and requests of said professionals. Otherwise said woman will soon find herself back in the very spot she apparently is complaining about and have NO ONE to blame but herself

NOW back to my earlier question

What do we do with those who are chronic abusers of drugs etc and health problems who have reached the stage where, because of the abuse of their bodies on the physical front ,will probably never be able to hold a job and in some cases care for themselves but refuse to even attempt to stop their addictions ior bad lifestyle choices?

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Otherwise said woman will soon find herself back in the very spot she apparently is complaining about and have NO ONE to blame but herself

She isn't complaining. She isn't blaming.

If what I have posted here makes her look like she is complaining and blaming, then I have done her a great disservice.

All I was trying to do was respond to Bowtwi's original post by explaining the life of one woman who was in nearly exactly the same situations Bowtwi had described.

Again, if I have painted her as complaining and blaming, I have done her a great disservice.

Trust me, she fully understands how she's screwed up her own life. Nobody needs tell her.

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Maybe instead of "complaining", I should have used the word "apathetic"...

Either way...

This woman's needs aren't getting met and additional action is needed.

Yes, I'm just an armchair quarterback in this game, but I do know how its played.

Lots of phones calls - lots of connections - some help is achieved.

I wish you the best in helping your friend.

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Well that takes a load off my mind

If she is in the hands of professionals then they will know if any programs that are there to meet her needs.

Of course it should go without saying that the woman in question needs to be willing to honestly and forthrightly comply with any and all suggestions and requests of said professionals. Otherwise said woman will soon find herself back in the very spot she apparently is complaining about and have NO ONE to blame but herself

NOW back to my earlier question

What do we do with those who are chronic abusers of drugs etc and health problems who have reached the stage where, because of the abuse of their bodies on the physical front ,will probably never be able to hold a job and in some cases care for themselves but refuse to even attempt to stop their addictions ior bad lifestyle choices?

Chronic abusers of drugs are generally labeled so by the local hospitals and other healthcare professionals in the area. In my area we have a network within the hospitals' emergency rooms and walk-in care centers to compare names and medications that are being asked for. If a patient is ER-hopping looking for pain medication they are confronted about it and they are referred to a pain program and they are not given narcotic pain medications to manage their pain. These patients are also referred to a social worker for assistance and they are connected to programs that are designed to help them. If the patients truly have a pain problem, they will comply (and grumble but comply, nonetheless) because they need to continue their medical care.

Unfortunately, we can not make choices for people. Of course, I'm not telling you something you don't already know here... but if we could make choices for people, then someone could have stopped me from having my fifth cup of coffee today and eating a sugary snack because both are bad for me. But I did it anyhow. On a more serious note, we can't stop people from shooting up H either. Thankfully, we have laws that put people who make really bad choices in jail. We don't have a lot of consequences for people who are out to milk the system, other than the label them such and shut down some of their assistance , a bit at a time, so they will hopefully stand on their own feet. I can tell you that, at least in my area, the people who serve in the system (i.e. the social workers, care managers, etc.) are pretty well networked to identify those who are chronic needy people and those who just need a little extra help because they're down on their luck at the moment.

I have no issues with the latter of the two - thank god that there - maybe I'll need it someday, who knows...

Edited by ChasUFarley
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NOW back to my earlier question

What do we do with those who are chronic abusers of drugs etc and health problems who have reached the stage where, because of the abuse of their bodies on the physical front ,will probably never be able to hold a job and in some cases care for themselves but refuse to even attempt to stop their addictions ior bad lifestyle choices?

To me there is a problem with the question here.

If someone has made such terrible choices in their lives, there is a reason. Until that reason is addressed, the person will never make better choices.

But if someone has deteriorated to the point of never being able to hold a job and/or care for themselves, and they continue in their bad choices with no desire to make better choices, therein lies the answer to your question.

What person of sound mind and body would actively choose to be like this?

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Until that reason is addressed, the person will never make better choices
The people I am speaking about have made the conscious choice to continue their lifestyle. The reason is quite, frankly, irrelevant. After you are an adult you have two choices ---to move forward with your life or not. You are in charge, unless there is a mental defect. if you choose to wallow in past wrongs, If you choose to behave as a child, If you choose to claim, bad parenting, the devil , economic status whatever to justify your behavior --that is your choice. You can choose to stop the justification in the same manner you chose to embrace the justification .

And Don't tell me it can't be done, I grew up with Paranoid Schizophrenic mother, who was protected from her actions, I've been a coke addict -which I kicked with no Treatment-I quit smoking again Cold turkey, I've been homeless, and jobless I have survived abuse etc etc. And I come out of it by making the decision to make better choices then doing it. Did I have friends yes, God Most definitely, Assistance yes--but ultimately I was the one who made the decision to change my behaviors and then followed through.

As a society we have made Gods of the mental health business and left the concept of free agency and self responsibility on the doorstep. "I can't", "Somebody has to help me", "It's not my fault", "My parents.........(fill in the blank)" Enough already--we need to face the fact that some people will never step up to the plate and take responsibility for themselves--the question then becomes just when do we as a society have an obligation to fund their misanthropic lifestyles

What person of sound mind and body would actively choose to be like this

People with mental handicaps lacking the intelligent or thought processing abilities to make these decisions are not what I am talking about.

As to the others -there are hundreds of people --many protected and enabled by family members- who choose to keep drinking, eating, drugging, not follow doctors orders, not take their medications, not make lifestyle changes-- knowing that their actions will be detrimental-- who continue to do so --with the attitude that they are entitled to live their lives as they please because "it's my life" "it's a free country". Then when the house of cards they have so shakily built starts to tumble around their ears they expect others including the welfare system to take care of them but still refuse to do anything to help themselves. Much as the woman you tried to help

What as a society do we owe these people??

Because this is the true moral conundrum of the system.

The able bodied we can make work

Those who fraudulently obtain assistance we cut off

but this category poses tremendous ethical, and moral conundrums

How do we address those issues is my question.

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The able bodied we can make work

Those who fraudulently obtain assistance we cut off

but this category poses tremendous ethical, and moral conundrums

How do we address those issues is my question.

To me this is very much like the issue of 'assisted suicide'. If someone is at the point of suicide, can that someone make their own choice about having assistance in committing suicide? Isn't assisting suicide really murder? Suicide is something one does to one's self. Having help is not suicide. Is it?

After you are an adult you have two choices ---to move forward with your life or not. You are in charge, unless there is a mental defect.
As to the others -there are hundreds of people --many protected and enabled by family members- who choose to keep drinking, eating, drugging, not follow doctors orders, not take their medications, not make lifestyle changes-- knowing that their actions will be detrimental--

It is a mental defect to continue damaging one's self. No matter the reason.

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To me there is a problem with the question here.

If someone has made such terrible choices in their lives, there is a reason. Until that reason is addressed, the person will never make better choices.

But if someone has deteriorated to the point of never being able to hold a job and/or care for themselves, and they continue in their bad choices with no desire to make better choices, therein lies the answer to your question.

What person of sound mind and body would actively choose to be like this?

You just answered your own question... with your own question.

They aren't of a sound mind and body - that's why. Generally undiagnosed or untreated mental illness is involved with many of these cases.

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