Ethical Decision Making in Situations of Self-neglect and Squalor among Older People

Abstract

Current approaches to professional ethics emphasise the importance of upholding the ethical duties of autonomy, beneficence, non-maleficence, and justice in practice. All are prima facie duties, meaning that they must be respected on their own and, if the duties conflict, it is assumed that the dilemma can be resolved through rational decision making. There are, however, a number of limitations to this approach to professional ethics. This paper explores these limitations through an empirical study that examined the ethical dilemmas facing 24 professionals in their work with older people who were self-neglecting or living in squalor in Sydney, Australia. The research uncovered that two groups of professionals interpreted autonomy in different ways. Furthermore, when faced with difficult ethical dilemmas, participants agreed that the most satisfactory responses involved strategies that closely mirrored elements of alternative approaches to ethics, particularly the ethics of care and virtue ethics. The findings point to the relevance of a pluralistic approach to ethics in professional practice.

Keywords:

• Autonomy
• Risk
• Ethics of Care
• Virtue Ethics
• Self-neglect
• Squalor
• Pluralism

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Notes on contributors

Shannon McDermott

Shannon McDermott works as a Research Fellow at the University of New South Wales in Sydney, Australia. She conducts research in the areas of ageing, disability, mental health, and social policy