Presumed Incompetent: Treatment of Persons in Long-Term and In-Patient Psychiatric Care Facilities

Over at Feministing, Katie has a pretty solid analysis of the recent case of a woman in an independent living facility who was unambiguously raped by a male employee. After reporting the rape, to which the perpetrator confessed, the survivor was portrayed by the facility as a “flirt” who “flirted mercilessly with that boy” (a 30-year old man) and who was making it up. Katie nicely points out that this reaction, though consistent with the way that sexual assault victims—especially women—are often treated, is complicated by ageism since the woman’s presence in a long-term care facility was taken by some folks to imply that her testimony was unreliable. Philosophers would see this as epistemic doubt of the survivor’s testimony based in part on the fact that the survivor in question is 89, irrespective of her actual competence. Katie mentions that the testimony of folks in long-term care facilities with respect to assault or abuse is often questioned on similar grounds.

Image Credit: Sebastian Bozon, AFP/Getty Images from Canada.com “One of the most complex and unexamined issues facing elderly care facilities is how to determine if residents with dementia have the mental capacity to consent to sex.”

In this case, the facility didn’t simply doubt the survivor’s testimony. That would be betrayal enough of the provider-patient relationship and the duty of care which they owe to her. In a horrific escalation, the facility transferred her to a psychiatric institution for several days after she reported the crime, during which time she had little interaction with staff and was in what appears to be solitary confinement.  Worse still, a very bad vaginal tear—one which a provider later said was the worst she’d ever seen from an assault—went untreated for the nearly 72 hours of her psychiatric confinement.

This reveals a fascinating—horribly fascinating—overlap between presumed incompetence* based on age and presumed incompetence based on mental illness. Indeed, both are often taken to be signs of cognitive impairment which lead to older persons and mentally ill persons being treated as less-than, as somehow sub-human, as deserving of less respect.   T. Szasz, in a short 2005 article for the, argued that while persons confined in mental hospitals are considered potentially competent in law, they are routinely treated as if they were incompetent. We saw this in a British case which recently came to light. In thatcase, a pregnant  Italian woman in Britain for job training had a severe anxiety attack, after not having taken medication for her treatable bipolar disorder, during which she was confused about reality and was taken for in-patient psychiatric evaluation. Rather than being restored to competency through getting back on her medication and then being set free, she was judged to be a long-term risk to the fetus. While still remaining in an in-patient psychiatric hospital a full 5 weeks later, she was taken for a pre-term C-section on the grounds that her fetus must be removed from her custody. She was not told what would happen and so did not consent to the procedure, and was not told the conditions under which she might regain custody. She is still fighting for custody of her child, 15 months old at the time the story broke in November of 2013. British Member of Parliament John Hemming said, “I think this has a fair chance of being the worst case of human-rights abuse I’ve ever seen. She wasn’t treated as a human being.” This case illustrates how woefully easy it is to assume that mentally ill persons are not only incompetent, but permanently incompetent, much as the elderly rape victim was treated as such. Insofar as long-term care facilities include not only the elderly but also younger disabled persons, we must consider how the mere fact of being in a long-term care facility or psychiatric institution contributes to presumptions of incompetence based in age, disability, and mental illness.

Image Credit: Thomas Day, National Care Planning Council

In cheap generic viagra pdxcommercial.com addition, men experience extreme fatigue due to excessive hand practice. However, you cialis for sale india need to have a prescription for the same as without a proper prescription you may harm yourself. Visual skills visual therapy is generic cialis without prescription designed for eye focusing, eye coordination and teaming, eye movement, and eye hand coordination. It causes precipitation purchase cheap viagra of the bile acids; very aggressive detergents. I urge that we take seriously the ways in which stigma and bias about gender, age, disability, and mental illness come together in long-term care settings to undermine providers’ own sense of the duty of care they owe to their patient-residents.  The issue goes beyond sexual assault or rape to the autonomy which long-term and psychiatric patient-residents are generally allowed, or not allowed, as the case may be. The most vulnerable and dependent among us are not identical to the most incompetent among us.  To presume incompetence not only gives rise to abuse, but is itself a form of abuse.

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