Examining ethical issues that arise in providing ED/hospital care for patients experiencing elder mistreatment and approaches to address them

ABSTRACT

Clinicians in the emergency department and hospital who treat patients experiencing elder mistreatment (EM) can expect to encounter challenging ethical dilemmas. Collaboration with ethics and EM consultation services offers teams an important opportunity to improve patient-centered outcomes and address value-based concerns when treating these patients. This article describes the role of a hospital clinical ethics consultation service and best practices for collaboration between ethics and EM consultation services. Illuminated via four case studies, the article presents several core ethical frameworks, including allowing patients the dignity of risk, considerations around a harm reduced discharge, involving abusers in surrogate decision making, and providers’ experience of moral distress when dealing with patients experiencing EM. Increasing collaboration with ethics and elder mistreatment services can help teams more effectively respond to EM.

KEYWORDS:

• Clinical ethics
• dignity of risk
• elder mistreatment
• harm reduction
• hospital consultation service

Acknowledgments

Attendees at the September 28–29, 2022 meeting included the authors of this manuscript and Sarah Cox, Jason Hayes, and Avery Ornstein. The authors wish to acknowledge the contributions of their colleagues.

The Vulnerable Elder Protection Team wishes to thank the New York Office of Victim Services (OVS), and the Vulnerable Elder Services, Protection and Advocacy Team (VESPA) wishes to thank the State of Colorado Office for Victims Programs (OVP).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

VEPT is currently funded by the New York Office of Victim Services [#C11419GG] and supported by a Paul B. Beeson Emerging Leaders Career Development Award in Aging [K76 AG054866] from the National Institute on Aging. VESPA is funded by the Colorado Office of Justice Programs, Victim of Crime Act Grant.