When protection becomes control: Assessing benevolent coercion in elder care.

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.