Elder abuse and vulnerability: Avoiding illicit paternalism in healthcare, medical research, and life

Abstract

Summary There is a clear need for paternalism in healthcare, medical research, and everyday life to protect some older adults from being illicitly harmed, abused, or exploited. The general justification for the outside intervention in these older adults’ decision-making is that these individuals are especially vulnerable as the result of cognitive impairment, lack of adequate education, poverty, or a host of other factors that will reduce the individual's autonomy to a level that will not enable sufficiently autonomous choices. Unfortunately, well-meaning efforts to paternalistically protect older adults are not always morally permissible, especially if they are based on false assumptions and beliefs about population vulnerability that border on ageism. In these cases, the protection becomes a form of elder abuse, which robs older adults of their autonomy and the respect they deserve for being moral agents in the community. To combat the unwitting slide into elder abuse, I propose that we first understand why these false beliefs about older adults’ vulnerability exist, and then put into place a framework that will empower older adults instead of harming them. To accomplish this goal, we will have to switch from Hedgehog cognition to Fox thinking.