Legal Implications Regarding Self‐Neglecting Community‐Dwelling Adults: A Practical Approach for the Community Nurse in Ireland

Abstract

This paper explores the current literature related to legal issues encountered by the public health nurse in Ireland in visiting clients exhibiting self-neglecting behavior. Nurses working in community settings where home visiting of clients is required will at some point encounter situations of client self-neglect. Possession of a clear legal framework for the local area that addresses both the nurse's professional responsibility and the client's rights is needed. Because a high incidence of depression and dementia seen in self-neglecting adults has prompted calls for wider screening of the agreeable client, an understanding of the definition of competence and capacity in the national legal system for that client becomes critical. In Ireland, as in many other countries, refusal of care or screening is the right of any competent adult. However, issues of mandatory reporting, confidentiality, and trespass may differ from other areas. Nursing care delivered at the community level to a client exhibiting self-neglecting behavior involves a delicate balance of trust and support. Through this overview of the legal implications for self-neglecting clients in Ireland, nurses have the opportunity to begin an exploration of similarities and differences in approach on a global level.

Nurses’ Encounters With Older Adults Engaged in Self-Neglectful Behaviors in the Community: A Qualitative Study

“…The central dilemma is whether to enforce treatment or let go; both options are motivated by the value of human dignity. The legal and ethical responsibility is unclear in situations where nurses need to simultaneously preserve the older adults’ right to refuse treatment and maintain their dignity (Ballard, 2010; Mattison, 2000; Mauk, 2011). The dilemma whether to save the older patient’s life or respect his wishes is further heightened when the nurse perceives the patient’s self-neglect as a form of suicidal behavior.…”

Conceptualising and responding to self‐neglect: the challenges for adult safeguarding

“…Some researchers and clinicians therefore propose that assessment should follow an 'articulate-demonstrate' model, encouraging the individual to outline their approach to decision-making and to illustrate how they will act on their conclusions (Sherman, 2008). The importance of assessment also emerges in the recommendation that individuals should be screened for conditions which may affect capacity (Dyer et al, 2007b;Ballard, 2010), such as depression, and in the recognition that cases may be managed differently depending on whether what is presented appears part of a life-long pattern of behaviour or a recent change (Pavlou and Lachs, 2008). Behaviour consistent with previous life choices could be regarded as authentic, a reflection of that individual.…”

“…The literature also recommends a broader multi-disciplinary structure than is often in place, including housing and public health (Lauder et al, 2005b). This is because of the potential need for social and medical interventions, the range of possible legal options, and the complexity of causes and consequences involved in cases of self-neglect (Day and Leahy-Warren, 2008;Ballard, 2010).…”

“…Knowledge of legal frameworks for intervention, either where the individual lacks capacity or where expressed wishes are overridden because grounds for lawful removal are met, emerged as very important for practitioners from the workshop participants, key informants and literature (Pavlou and Lachs, 2008;McDermott et al, 2009;Ballard, 2010). The legal rules on interventions, involving mental health and mental capacity, human rights and information sharing, public health and social care legislation, coupled with the High Court's inherent jurisdiction powers in respect of vulnerable adults, were experienced as complex and not well understood by all working in the field, and this is borne out in the literature (Gunstone, 2003;Lauder et al, 2005c;Harbottle, 2007;Perkins et al, 2007, Pinkney et al, 2008.…”

Ethical concerns of visiting nurses caring for older people in the community

“…For a successful nursing practice, we must have an understanding of the ethical aspects of nurses' interactions with clients. 7 There have been several studies on the ethical issues related to visiting care services, such as the potential injustices of home-care practice, 8 self-neglect, 9 the dignity of clients, 10 and the challenges of ethical decision-making. 11 Yet, little is known about the ethical concerns of visiting nurses.…”