No ethical consensus has yet been reached, underlining the need for clear(er) policies. More research is thus recommended to determine ethical and practical viability of surveillance technologies whereby research should be specifically focused on the resident perspective.

Client experiences of surveillance technology appear to entail a certain ambivalence. This is in part due to the variety in surveillance technology devices, with each device bringing its own connotations and experiences. But it also lies in the devices' presupposition of an ideal user, which is at odds with the actual user who is inherently vulnerable. Surveillance technology can contribute to the autonomy of clients in long-term care, but only if it is set in a truly person-centered approach.

General rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: http://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. Results The views generated are grouped into six categories ranging from the need for a right balance between freedom and security, to be beneficial and tailored to the resident, and clearly defined procedures to competent and caring personnel, active monitoring and clear normative guidance. The results are presented in the form of a graphic chart. Conclusions There appears to be an inherent duality in the views on using surveillance technology which is rooted in the moral conflict between safety and freedom. Elaboration of this ethical issue has proved to be very difficult. INTRODUCTIONAs we live in an increasingly ageing society, nursing homes are continually battling with an expanding population of patients with dementia and a decreasing workforce. One potential answer to this problem might lie in the use of technology. Sophisticated technological devices, in particular those aimed at monitoring and safeguarding residents, could not only support and assist staff but might also alleviate the growing pressures on an already overburdened care system. 2However, the use and application of surveillance technology (ST) in dementia care has led to considerable ethical debate among healthcare professionals and ethicists. There are those, for instance, who view the use of ST as either an infringement of human rights or as contrary to human dignity, as it reduces or infringes privacy and removes personhood, not to mention its stigmatising effects.2e4 Furthermore, resorting to technology in general might result in a reduction in the essential human contact between caregivers and residents and could lead to a further decrease in staff in long-term care facilities.5e8 On the other hand, proponents of ST have stressed that usage will not only create a more secure environment (thereby reducing caregiver stress), but also increase liberty and dignity when compared with a policy of incarceration. 9 10What can be discerned by some of the contrasting views, and is also corroborated by an extensive literature review by Niemeijer et al, 11 is that no ethical consensus has yet been reached, underlining the need for clear(er) policies and guidelines.In advance of a guideline that can count on support from within the field, it is importa...

In the Netherlands, physical/mechanical restraints in the care provided to people with intellectual disabilities are still in use, with the case of "Brandon" being a recent and illustrative example. The public debate that this case triggered raised questions concerning the policy proposal in the Care and Coercion Bill (Wetsvoorstel Zorg en dwang) and efforts to reduce the use of restraints. Thus, the authors undertook an inventory of government legislation and institutional regulations in order to obtain an insight into practices applying in other countries and to provide recommendations for developing policy on reducing the use of restraints in the care of people with intellectual disabilities in the Netherlands. Using a literature study, they observed that although the use of restraints in the care for people with intellectual disabilities is internationally regulated by the criterion of ultimum remedium, policy is clearly not always in line with practice. Various studies of best practices have identified some common elements in seeking to limit restrictive interventions, including strong leadership in care facilities based on national policy, trained staff, a strict monitoring system, and changes in attitudes on the use of restraints, with restraints being identified as treatment failure. The authors noted that the use of restraints, and efforts to reduce their use, is a dilemma internationally. In the Netherlands, the public debate on the use of restraints has not so far led to any significant political action. While decisions on a new legal framework still have to be made, it would be advisable to include a section on jurisdiction in the policy framework and to ratify the UN Convention on the Rights of Persons with Disabilities, which has many implications for both policy and practice. In the meantime, care facilities can start working on implementation plans, including the best practices described in this study.

Policies limit the use of coercive measures as a measure of last resort to protect people from danger. Success of policies can only be determined by registering the use of coercive measures. The reliability of 57 standardized coercive measures was tested. In addition, implementation was investigated of improved registration in a residential care setting. This mixed methods study within a residential care organization for people with intellectual disabilities in the Netherlands included 55 living units and 269 residents. Reliability of 57 standardized coercive measures was tested against other informants (colleague staff, trained outside observer) and results were validated by a panel of stakeholders. Second, the implementation of a mandatory routine registration system was investigated by comparing registration of coercive measures to personal files of 30 residents. Registration of coercive measures yielded reliable data for at least 25 out of 57 types of coercive measures. The second part of the study showed widely varying explanations of unreliable data by stakeholders, including knowledge and awareness of coercive measures of support staff and the influence of contextual factors on the encoding of coercive measures. After implementation, 46% of the coercive measures were registered in the registration system. Comprehensive registration of coercive measures by staff neither appeared feasible nor yielded reliable data. Clearly, multidisciplinary discussion among support staff and professionals is needed to decide whether care practices are restrictive or not. Further research should focus on how these considerations can lead to a reliable and meaningful registration.