Ethical and Legal Issues in Treating Elder Abuse Essay

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Elder abuse is a complex and multifaceted problem often requiring the collaboration of professionals from a variety of disciplines. When professionals with varying roles, responsibilities, and ethical guidelines work together, ethical and legal issues related to those professional differences are bound to arise. In elder abuse practice, three key ethical and legal issues that may come into conflict are (1) the legal duty to report certain suspected conduct to law enforcement and/or protective services versus victim autonomy and safety; (2) the victim’s right to self-determination versus protection and safety; and (3) when intervening, selecting the least restrictive alternative versus protection and safety.

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 cognitively 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 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.

In elder abuse cases, one of the challenges with using an empowerment model is that some older victims may not be able to make their own decisions due to dementia or other cognitive challenges. Often the risks of serious harm or death are heightened due to the advanced age and health status of some victims. Professionals may assess that if an older victim remains in the current situation he or she will die or be seriously harmed. These professionals may feel a moral and ethical obligation to step in and make decisions for the older victim to keep him or her alive. Self-determination may be seen as less important or critical to decision making. Desires of the older victim may not be considered, even if they could be incorporated into an intervention. The ethical and legal dilemma is differentiating situations when decisions must be made for an older victim from situations in which professionals use their authority unnecessarily or without attempting to create interventions that incorporate victim desires to the extent possible.

Least Restrictive Alternative versus Protection And Safety

A guiding principle in the elder abuse and health care fields is to use the least restrictive alternative for older individuals. For example, if an older individual needs some care, ideally services can be brought into the home. If that option does not provide enough support, then the older victim may be moved to assisted living, and finally, only if necessary, to a nursing home.

In elder abuse cases, professionals can disagree on what is the least restrictive intervention needed to achieve protection and safety. For example, adult protective services workers may listen to an older victim who wants to remain at home and insist that no action be taken that results in a move. Health care providers working with that same individual may assess the situation and determine that the older patient must be moved to a facility or he or she will die. One of the legal and ethical challenges facing any interdisciplinary team is wrestling with these complex situations and developing a plan that focuses on the older victim’s safety and needs with the least loss of independence to him or her and harmonizes these competing considerations.

Multiple or interdisciplinary responses to elder abuse cases are often the most effective responses. When professionals work together, ethical and legal challenges often arise. Preplanning among team members to develop a process for discussion and decision making in these tough cases can be useful to ensure that victims’ needs are addressed and teams continue to work together cohesively.


  1. Brandl, B., Dyer, C., Heisler, C., Otto, J., Stiegel, L., & Thomas, R. (2006). Elder abuse detection and intervention: A collaborative approach. New York: Springer.
  2. Heisler, C., & Brandl, B. (2002). Safety planning for professionals working with elderly and clients who are victims of abuse. Victimization of the Elderly and Disabled, 5(4), 65–78.

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