Ethical and Legal Issues, Treating Elder Abuse

Duty to Report versus Victim Autonomy and Safety

Most states mandate that some professionals or the entire community report cases of elder abuse to social services and/or law enforcement. In enacting elder abuse reporting laws, legislators were guided by the belief that older individuals, like children, are in need of protection and assistance, are physically or cogni-tively frail and more vulnerable, are at risk for abuse, and may be unable to report for themselves. As a result, professionals and others should be required to contact social services and/or law enforcement.

The duty to report can create ethical dilemmas for some professionals. Many older individuals are healthy, active members of the community. They are capable of making their own decisions about their lives, including whether they want professional intervention when they are being harmed. Some victims are at greater risk of being seriously harmed or killed by an abuser if they leave or get help from professionals. Older victims may have thoughtful reasons for not wanting professionals to report abuse and may accurately understand that they are at greater risk following a report.

Some professionals also are concerned about the breach of confidentiality and trust that can occur if a report is made. Health care providers and advocates are concerned that an older individual may decline to accept or stop using their services if a report about abuse is made to adult protective services.

Victim's Right to Self-Determination versus Protection and Safety

Weighing the victim's rights to make personal decisions against the potential risk of harm or death is a difficult task in any case of abuse. These competing principles may be even more complicated in elder abuse cases. On the one hand, most elder abusers use a pattern of coercive tactics to gain and maintain power and control over the victim. These abusers set the rules for the relationship (such as when dinner will be served, and who can come and go from the home) and deny older victims their right to make decisions in their own lives. Well-meaning professionals who see elder abuse cases may make decisions for victims with capacity because they believe the victim is older and may have dementia or because of discomfort or anxiety with the victim's choices. They may believe [Page 230]that the older victim is unable to make wise choices and needs assistance making these choices. For example, a case management plan may outline specific steps the professional believes a victim must take to live free from the abuser overriding the victim's right to consider alternatives and then decide what if any actions are desired.

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