Ethics of technology and restraints in residential care for people with dementia or intellectual disabilities: Development of a multidisciplinary guideline for safe care (WC2006-053)

Background

In recent years various research – among which the second evaluation of the Special Admission to Psychiatric Hospitals Act (BOPZ) – has endorsed that the current judicial framework for freedom restriction in the care for elderly with dementia and people with intellectual disabilities does not offer the necessary legal protection to patients/residents who are faced with freedom restrictions.
The current judicial framework also fails to correspond with concepts of good care as they have been developed from within the field. Moreover, traditional institutionalised care is increasingly shifting towards small scale living arrangements whereas new care supportive -and safety enhancing technology (surveillance technology) is becoming increasingly important. This technology has on the one hand the aim of increasing safety and quality of life and serves, on the other hand, as an alternative to the more traditional ‘hard’ freedom restrictions.

However, the use of surveillance technology (ST) in relation to cognitively impaired people provokes conflicting reactions amongst health care professionals and ethicists. What is more, the legal status of ST remains unclear, underlining the need for clear(er) policies and guidelines. Nonetheless, more and more care homes are presently introducing ST, most of the time without much practical and ethical guidance. Because of this lack many service providers have to find their way tentatively with regard to a responsible application of ST. In a report by the Dutch Health Inspectorate in 2009 the need for a clear normative framework regarding the application of ST was underlined.

The goal of this research project is thus to develop a multidisciplinary guideline for the responsible application of surveillance technology in the residential care for elderly with dementia and people with intellectual disabilities.  As well as all the developments in the field to decrease all applications of freedom restriction, there is also a proposed law for freedom restriction in preparation in order to replace the current Special Admission to Psychiatric Hospitals Act (BOPZ). The results of this research project could contribute to the further consolidation of the legal proposal and a better implementation of new regulations.