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Autonomy and
Self-Determination

Critical Issues
     
     
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Role of Culture in
Elder Abuse

 
   
  Mental capacity, consent, and
undue influence
 
   
 

Elder abuse and substance abuse

 
   
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Critical Issues in
Elder Abuse
 
     

Professional practice in the field of elder abuse prevention is guided by principles that highlight clients' freedom and civil liberties. In working with victims and vulnerable persons, professionals look for ways to prevent abuse that promote autonomy and self-determination. Autonomy, which comes from the Greek word for "self rule," is the ability or capacity to make informed choices, free of coercion, based on one's own personal beliefs and values. All adults are presumed to have decision-making capacity and are therefore afforded the right to self-determination, that is, the freedom to make decisions for themselves in all areas of their lives. The concept of autonomy reinforces this right to be free from unwanted interference, which means that there must be legal justification for any curtailment of autonomy.

Exceptions to Client Autonomy

Although the principals of autonomy and least restrictive alternatives apply to most cases, there are two situations in which clients' personal freedom may be compromised in favor of other compelling interests. Two legal principles may come into play in those situations:

Parens Patriae

When individuals are deemed incapable of protecting themselves from harm, society assumes responsibility for providing protection. Parens patriae, or the "state as parent," is a common law principle, which authorizes the state to act as a benevolent parent to protect its citizens who are impaired and cannot protect themselves. It allows for government entities, including APS, to initiate both voluntary and involuntary services for individuals who cannot protect themselves.

Police Power

The right to autonomous decision-making must also be weighed against the State's interest in preserving and protecting life and property. The principle of police power gives police the authority to curtail and control certain personal behaviors to protect the public welfare, as well as individuals. Police may intervene to protect individuals and the community from physical harm or the threat of harm, loss of assets and property, and public nuisances.

Least restrictive alternatives

In offering service options to their clients, professionals look for the least restrictive alternatives - interventions that cause the least disruption or change in the older person's circumstances and which maximize their independence and freedom. For example, if an individual is having trouble managing his or her financial affairs as a result of forgetfulness or other cognitive impairments, a very effective means for stopping the abuse would be to petition a court to appoint a guardian. Guardianship, however, is a very restrictive alternative in the sense that it strips people of very basic civil liberties. The principle of least restrictive alternatives dictates that other less restrictive options, such as informal money management, be considered prior to considering this option.

Resources for learning more about autonomy and self-determination:

Johnson, T.F. (1995). Elder mistreatment: Ethical issues, dilemmas, and decisions. Binghamton, NY: Haworth Press.

 
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