L’échec de la déontologie dans un contexte de maltraitance par négligence en gériatrie

Abstract

ObjectivesFor some years in France, the elder abuse is a phenomenon that does not fail to make the news, leaving in the shade centuries of denial of its existence. Thus, its knowledge has spread from specialized professional environments (forensic, gerontology, social) to the general public. It now plays a major role in professional training programs in geriatric institution with the center terms of ethics and deontology. Such negligent acts are not without consequences for the relationship of caregivers with deontology, how about the status of the deontological rule? We choose for it to focus our study on the review of deontology, that is to say, all the rules and responsibilities governing the care practices, including our clinical work which points to an inherent contradiction, or even a paradox. Material and methodsThis article is based on a clinical work done in the public nursing home to which we are attached and presents a series of meetings with Sylvie, Frédérique and Emilie, caregivers. It seems important to introduce the context and the working conditions in which they evolved professionally when these interviews were conducted. They are inseparable themes that we propose to process, namely repetition and neglect. For a variety of reasons: Lack of staff due to illness, repeated absences, non-renewal of contract for budgetary reasons, caregivers found themselves understaffed for a nursing home of 82 elderly residents. To give an example, they were during the mornings (time when the workload is the largest in nursing home) two per floor (each including 25 to 30 residents). In terms of tasks to perform, this includes the awakening of residents, breakfast service, daily toilet (partial or integral assistance; the residents are mentally and physically dependent), the acts of care, help with dressing, etc. This context can inexorably drift towards a set of practices together under the name of neglect in geriatrics. This is why we have paid special attention to the exploration of the care relationship and workload during our interviews. One of the challenges in the analysis of these interviews was to understand the genesis of a negligent behavior; highlight the nature and operation, both singular and institutional, which led to the emergence of the phenomenon. Thus, the workload becomes too large in view of staffing ratios, this cannot be separated from negligent phenomena which becomes the correlate. ResultsThis interdisciplinary study made it possible to note a state of failure of the deontology within the geriatric institution when this one is confronted with the phenomenon of the neglect in elder abuse. This failure, even this cancellation, proved during the analysis of the deontological regulations concerned in the institution using deontic logic, where those showed their contradictory state. These institutional mechanisms and the suffering which they induce for the caregivers clearly could be highlighted. The clinic that we analyzed thus made it possible to clarify the situation of moral dilemma in which are locked up and in addition the situation of double-bind (in reference to the paradoxal injunctions of Watzlawick) implementation by the deontological regulation placing the caregivers in an insupportable position. In opening, this research makes it possible to foresee with which constraining force, about an organized compulsion (Quaderi, 2004), the institution precipitates its subjects in the repetition which, by blocking the construction of the memory, involves an impossible setting with the past of the elder abuse.