Susan B. Somers, JD

1

Do the Principles of Autonomy and Independence
collide with Ethically Serving Self-Neglecting
Older Persons?

• Susan B. Somers, JD
• Secretary-General INPEA

2
Concept of Autonomy

• autonomy is primarily a phenomenon involving
  independence of action, speech, and thought.
• It provides the broad foundation for a wide
  range of political, legal, civil, and human
  rights and the philosophical basis on which
  individuals can resist the coercive interference
  of external authorities or powers in their
  lives. (Agist, 2nd Edition)

3
Autonomy links to Independence

• Autonomy a concept respected in situations of
  intervention with older self neglecting adults.
• Strongly related the concepts of Self
  Determination and Independence
• Independence in later life often
• synonymous with remaining in ones own home for
  as long as possible.

4
Definitions of Autonomy

• the meaning of the word autonomy in Greek
  history as self-rule,
• freedom to determine ones own actions or
  behavior (Colliers Dictionary)
• vs. Health Care Dictionary
• having the ability to function independently
  (Blackwells Dictionary of Nursing)

5
States Authority to Intervene

• Concept of Parens Patriae Father of the Land
• Police Powers

6
Framing the issue

• When Self-Neglect collides with
  Self-Determination
• Hoarding
• Medical neglect
• Self harming behaviors

7
A Dallas man, who had been missing two weeks,
found dead inside his home under piles of trash.
DALLAS (CBSDFW.COM)
8
A house so jammed with clutter took two days
before the homeowner's body was finally
discovered amid the debris,
9
WHO World Report on Violence and Health2002

• Preventing deaths by violence within a public
  health framework
• Utilizing evidence based practice
• US Institute of Medicine conducted a Follow up to
  WHO 2002 Report
• June 26-27 Wash. DC

10
Violence by type, WHO

• Interpersonal,
• Domestic/Family Violence
• Self inflicted,
• Suicide
• Collective Violence
• Wars, conflicts, etc

11
Suicide A preventable form of Self Neglect and
Self Violence

• Suicide 54 of all violent deaths

12
Legal Competency vs. Individual Capacity

• Traditional notions All adults are deemed
  competent unless adjudicated otherwise

13
VI. Assessing Individual Capacity for
Self-Determination
14
VII. Involuntary Interventions

• When
• How

15
VIII. Professional Ethical considerations

• Lawyers Ethics
• Social Work Ethics
• Medical Ethics

16
References

• Dependence and Autonomy in Old Age
• An Ethical Framework for Long-Term Care, Second
  and Revised Edition
• George J. Agich
• The Meaning of Independence for Older People in
  Different Residential Settings
• Sarah Hillcoat-Nallétamby