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.


  • 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?

Psych referral to help determine legal capacity:

ED - consult available in ED 24/7

Inpatient -
pager x15894

Outpatient -
if needed ASAP send patient to ED, or schedule appt. at 498-9111

Ethics committee referral

24/7 Pager x16230