Ethics

Some issues of note:

• The report to Adult Protective Services is anonymous by law to the patient and family. However, you may choose to disclose reporting requirements and/or that you are filing a report. Ethical issues that may arise from this:
  • Do you disclose the limits of confidentiality prior to talking to the patient and/or the caregiver - that what they say may require you to report?
  • Some feel it is preferable to disclose the report to patient and family. (This provides an opportunity to "reframe" the process in a positive, constructive manner.)
  • Physician’s mandatory duty to report supersedes patient wishes, and may damage the doctor-patient relationship. (Explain your first concern has to be his/her safety and well being.)
• Competent patients have the right to choose to stay in an abusive setting, which may be difficult for healthcare providers.
• Competent patients who become unable to perform the activities of daily living (self neglect) may require assistance or relocation which they do not want.
• Incapacitated patients who insist on staying in an abusive setting may need conservator appointment.
• In some cultures, abuse is handled as a private family problem, and outside interference is not appreciated and actively discouraged.

Privacy

• Make sure you know who, legally, you can talk to about the patient.
  • What are the patient's wishes about privacy?
  • Is the patient conserved?
  • Who is the healthcare surrogate, if there is one?
  • Have all family members agreed to a family spokesperson for communication, and does the patient agree with this?