By Stacey Kusterbeck
At Saint Louis University, clinicians often want ethicists to help with two questions involving elder mistreatment, reports Kelly Turner, MA, a PhD student in Health Care Ethics at Saint Louis University:
• Should clinicians seek institutional intervention to prevent an abusive or neglectful surrogate from being involved in medical decision-making?
Healthcare providers, aware of their ethical obligations of non-maleficence, understandably want to prevent patients from being harmed by a surrogate who does not have the patient’s best interests at heart. “The problem is that elder mistreatment cases are very rarely straightforward situations in which the surrogate has been proven to act with the explicit intention of harming the patient,” says Turner.
Concrete evidence that a surrogate consistently has abused an older adult patient is a strong reason for ethicists to consider intervention.
“But if a family member has misused an older adult patient’s financial assets before, does that prevent them from making medical decisions that reflect the patient’s wishes and accord with their best interests?” asks Turner. “There’s no one-size-fits-all approach to these cases.”
• Is it appropriate to discharge an older adult patient home if clinicians are concerned the caregiver is unable to meet the patient’s care needs?
In cases of suspected neglect, it can be hard to ascertain whether the patient’s primary caregiver simply needs additional resources or whether it would be better to find a facility placement for the patient. Patients may express (or previously have expressed) a strong preference to remain in the home setting.
“We have to balance our obligations to protect patients from avoidable harms while attempting to honor their preferences and interests — for example, remaining in a family home for as long as possible,” says Turner.
There often is no clearcut answer. Ethicists still can suggest ways to mitigate harm. It might not be necessary to remove a surrogate accused of elder mistreatment from the decision-making process altogether. However, ethicists can attempt to bring in other family members or friends. “This is an added layer of protection, to ensure that a patient’s values and interests are being safeguarded,” says Turner.
