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The Resident-intruder Paradigm: A Standardized Test for Aggression, Violence and Social Stress
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When protection becomes control: Assessing benevolent coercion in elder care.

Wang Zhang1, Wenhao Xu1, Yu Zhang1

  • 1School of Humanities, Southeast University, Nanjing, China.

Nursing Ethics
|June 15, 2026
PubMed
Summary

Elder care safety measures can infringe on autonomy. This study introduces a Relational Legitimacy Framework (RLF) to ethically guide restrictive practices, ensuring dignity and privacy while balancing safety and care.

Keywords:
benevolent coercioncare ethicsrelational autonomyrelational legitimacy frameworksafety justification

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Area of Science:

  • Gerontology
  • Bioethics
  • Digital Health Ethics

Background:

  • Elder care prioritizes safety, often leading to restrictive measures that may compromise older adults' freedom, privacy, and dignity.
  • Digital care technologies exacerbate tensions between continuous monitoring and personal autonomy.
  • Current ethical debates on elder care restrictions are often limited to autonomy vs. beneficence or privacy compliance.

Purpose of the Study:

  • To conceptualize restrictive elder care practices as 'benevolent coercion' grounded in care ethics and relational autonomy.
  • To develop a Relational Legitimacy Framework (RLF) for ethically evaluating and governing restrictive measures in elder care.
  • To provide practical guidance for healthcare professionals and institutions on integrating ethical decision-making into the use of restrictive measures.

Main Methods:

  • Grounded in care ethics and relational autonomy theory.
  • Developed the Relational Legitimacy Framework (RLF) with specific criteria for justification.
  • Utilized the Chinese context to examine the practical application and potential failures of the RLF's conditions.

Main Results:

  • The RLF requires restrictive measures to be necessary, proportional, and minimally intrusive.
  • It mandates relational procedural legitimacy, including valid consent and withdrawal options.
  • The framework emphasizes non-negotiable dignity and privacy protections, time-limited reassessment, and exit mechanisms.

Conclusions:

  • The RLF offers a 'normative braking system' for safety-based justifications in elder care.
  • It provides a theoretical foundation and practical guidance for ethical decision-making regarding restrictive measures.
  • The study highlights the critical need for robust governance and ethical oversight in implementing safety measures in elder care settings.