A care-home resident with Alzheimer's (a former executive secretary) tries to leave the home several times a day and puts herself in danger. Nurses can (a) bring her back, by force if needed, (b) call her back with a fake phone call appealing to her work ethic, or (c) walk with her and talk. How do the principles judge the options?
(a) Force violates autonomy and damages trust; (b) the fake call deceives her, so she has no choice between reality and deception, and others may fear being deceived too; (c) the walk respects autonomy, beneficence and non-maleficence, but costs the most staff time, which may be taken from other residents. On principles (c) is best; from the care perspective the fake call can still be judged positively when (c) is not feasible.
| Option | Likely course | Principles |
|---|---|---|
| a) Reorient and bring back, by force if needed | she will not see why she must go back; trust suffers; she will try again | against autonomy; nurses may suffer from using force |
| b) Fake phone call ("you're needed at work") | her drive (duty as a secretary) is confirmed; briefly content because she can "work"; she will try again | impairs autonomy: no choice between reality and deception; quick and time-saving, but a lie that weighs on nurses; residents who see it may fear being deceived too |
| c) Walk outside, talk, validate her feelings (e.g. appreciate her work) | she follows her urge to leave, forgets her goal while talking, returns with the companion; may try again later | respects autonomy, beneficence and non-maleficence; but costs the most time and needs trained staff, and time saved elsewhere may harm other residents |
The weighing: (a) and (b) are hard to reconcile with beneficence and non-maleficence because the relationship of trust suffers, and autonomy speaks against them too. (c) honours all principles but runs into implementation problems (time, trained staff). So in the end, the fake call can be judged positively from the care perspective (Fürsorge): it calms her without force.
Option (c) is a form of validation: accepting the person's reality and feelings instead of correcting them.
Go deeper:
Erdmann (2024) — the full case of "Frau Meier" and its weighing (German).- Wikipedia: Validation therapy — the communication approach behind option (c).