A View from the Ethics of Care
Imagine for a moment a person who has dedicated their entire life to work, raising a family, contributing to society. Now, in their golden years, they find themselves in a vulnerable situation, facing not only the challenges of aging but also the invisible pain of abuse, often in silence and within their own home. This reality, affecting one in six older people worldwide according to the World Health Organization, represents one of the most serious violations of human dignity and raises profound bioethical dilemmas that our society cannot ignore 3 .
By 2050, people over 60 will reach 2.1 billion, making ethical reflection on elder abuse urgent and unavoidable 3 .
Elder abuse manifests in multiple forms: physical, psychological, economic, and neglect. Underlying these expressions of violence are essential questions about the value we assign to human life in its final stage, our duties toward those who preceded us, and the ethical limits of care. Bioethics, as a discipline that studies human behavior in the field of life and health sciences in light of moral values and principles, emerges as a fundamental tool to analyze and address this growing phenomenon 1 .
of older adults reported having suffered some type of violence in a study at the San Pedro Claver Foundation in Ecuador
older people worldwide experience abuse according to WHO estimates 3
Includes hitting, pushing, and deprivation of basic needs such as food.
Expressed through insults, threats, humiliation, and social isolation.
Comprises theft of belongings, pressure to hand over goods and properties, and undue financial control.
Manifests as lack of adequate medical care, neglect in personal hygiene, and abandonment in food provision.
The impact of these abuses transcends the immediate. Research indicates that victims experience serious consequences such as physical injuries, illnesses, depression, post-traumatic stress, social isolation, and loss of autonomy . These effects are aggravated by the reality that many cases are never reported, either due to fear of retaliation, shame, or emotional and economic dependence on the abuser, creating a hidden figure that could be much higher than officially recorded.
Considers the elderly person as the origin and center of moral values, deserving dignified treatment regardless of physical or cognitive abilities 1 .
Emphasizes relationships of interdependence and responsibility toward those in vulnerable situations 1 .
Values decisions based on their utility and cost-benefit, which can lead to neglect of older people when perceived as "social burden" 1 .
"The Cuban study found that, while the personalist approach and ethics of care predominate, there is an assistentialist bias that ends up limiting the active role of older adults in their daily lives, denying them agency and autonomy" 1 .
A particularly relevant perspective is the so-called "bioethics of health care", which emphasizes the human relationship between the health professional and the patient, valuing patient centrality in care 2 . This approach is based on:
This framework is especially pertinent for older people with dementia or other conditions that limit their autonomy, where the balance between protection and respect for autonomy becomes particularly delicate.
Review of specialized literature and official statistics on elder abuse.
Development of research instruments (observation guides, interview protocols, and focus group questions).
Implementation of data collection techniques over a three-month period.
Coding and categorization of information obtained to identify patterns and recurring themes.
Contrasting findings with participants and experts on the subject.
Many victims perceive abuse as "something normal" or "deserved" .
Particularly vulnerable to specific forms of gender violence added to age-based violence .
A determining factor in the perpetuation of abuse .
Formal and informal caregivers experience high stress levels that, without adequate support, can lead to neglect or abuse situations .
| Type of Abuse | Main Manifestations | Relative Frequency |
|---|---|---|
| Psychological | Insults, threats, isolation | Very High |
| Economic | Theft, pressure to transfer assets | High |
| Negligence | Lack of medical care, hygiene neglect | Medium-High |
| Physical | Hitting, pushing, food deprivation | Medium |
| Type of Consequence | Specific Effects |
|---|---|
| Physical | Visible injuries, aggravated chronic illnesses, malnutrition |
| Psychological | Depression, anxiety, post-traumatic stress, low self-esteem |
| Social | Isolation, loss of support networks, forced dependence |
| Existential | Loss of autonomy, feeling of hopelessness, questioning life's meaning |
One of the central dilemmas in geriatric bioethics is the tension between respect for the autonomy of the elderly person and the need for protection when their decision-making capacity is compromised. Fernando Lolas Stepke, Director of the OPS/OMS Regional Bioethics Program, points out that "every norm of behavior lacks meaning if there is no freedom to accept or reject it" 4 . When this freedom is curtailed through abuse, the person's identity as an autonomous moral agent is affected.
Population aging poses significant challenges in the distribution of health and social resources. Lolas Stepke warns that the increase in older people "will be accompanied by a demand for services in the final stages of life of unprecedented proportions" 4 . In this context, abuse can manifest as age discrimination (ageism) in access to health services, social opportunities, and economic resources.
In frail elderly patients or those with terminal illnesses, the dilemma arises between prolonging life at all costs or prioritizing quality of life. As Raúl Padrón Chacón points out, "attitudes aimed at preventing the development of diseases or secondary complications are fundamental" in geriatric care 5 . Abuse can be expressed as excessive medicalization that ignores the patient's wishes or, conversely, as negligence in basic care.
| Dilemma | Poles of Conflict | Contexts Where It Arises |
|---|---|---|
| Autonomy vs. Protection | Right to decide vs. Duty to protect | Fluctuating cognitive capacity, dementia |
| Quality vs. Quantity of Life | Present well-being vs. Life prolongation | Terminal illnesses, chronic pain |
| Assistentialism vs. Empowerment | Comprehensive care vs. Fostering autonomy | Physical disability, moderate dependence |
| Limited Resources | Individual needs vs. Collective welfare | Overloaded health systems, low-resource contexts |
Faced with the challenge of elder abuse, bioethics is not limited to analysis but proposes concrete paths of action. WHO points to several effective strategies 3 :
Assistive technologies represent a promising field to promote autonomy and prevent neglect-related abuse. These devices, which include GPS systems for people with dementia, companion robots, and cognitive stimulation games, should be implemented from a person-centered approach that complements but never replaces human care 2 .
The ultimate solution to abuse requires a profound cultural transformation. As the Cuban study concludes, "symmetric bonds in the relationship with older adults are needed, taking into account the levels of help that old age progressively requires" 1 . This implies moving from an assistentialist model that infantilizes toward a model of respectful accompaniment that recognizes the full dignity of the person at all stages of life.
"Dialogue is the most important tool that the bioethical discourse has come to contribute to modern societies" 4 .
Elder abuse is not just a public health problem or a legal issue; it is fundamentally an ethical challenge that questions our values as a society. The bioethical perspectives exposed here - from personalism that reaffirms the inviolable dignity of every person, to the ethics of care that emphasizes our interdependence - offer valuable frameworks to understand and address this complex phenomenon.
The research at the San Pedro Claver Foundation reminds us that behind the statistics there are real stories of pain and resistance . Listening to these voices, traditionally silenced, is the first step to building a truly inclusive society where old age is not synonymous with vulnerability and contempt, but one more stage of the human journey, worthy of respect and care.