A Case of Protecting an Older Client
Rose, an older adult, takes great pride in her independence, her ability to take care of herself, and in not being a burden to her family. Her therapist, Arman, is impressed with her independent spirit. Rose eventually divulges to Arman several episodes of forgetting to turn off the gas flame in the kitchen. She laughs it off by saying, “I guess I’m not perfect.” Every so often, Rose discloses similar episodes of forgetfulness that have potential lethal consequences. Arman becomes increasingly concerned and suggests that she notify her family of her problem. Rose lets Arman know that this is not an option because her family has wanted her to move to a nursing home. Rose is adamant in her refusal to go along with their plan. She tells Arman, “If you make me leave my home, there is no point in living.”
• If you were Rose’s counselor, what course of action would you take?
• What ethical, legal, and medical issues can you identify in this case?
• Is there a duty to protect in this situation?
Commentary. The therapist cannot afford to become sidetracked by Rose’s insistence that there is no reason to worry or by ignoring Rose’s hint of suicide. It is more important for the therapist to take action to help the client than it is to have her like the therapist. As Arman suggests, a meeting with the family can be of great benefit to all concerned. In our view, Arman does have a duty to protect Rose from accidentally harming herself, and possibly others, as a result of her cognitive impairment. By working closely with Rose, her family, and appropriate authorities, he may be able to help Rose transition to an arrangement that is both safe and acceptable to her. The counselor might also help Rose see some of the potential positive elements in leaving her home, such as fewer things to worry about and being given useful assistance.