When protection becomes control: Assessing benevolent coercion in elder care

Abstract

In elder care, “safety” is frequently accorded overriding moral priority. As a result, restrictive measures introduced under the banner of risk prevention are readily treated as “reasonable protection,” while, under the guise of care, they can encroach on older persons’ freedom, privacy, and dignity. The expansion of digital care technologies reinforces logics of continuous monitoring and alerting, thereby intensifying this tension. Existing debates often remain confined to an “autonomy versus beneficence” framing or to compliance-oriented privacy governance, and thus struggle to specify clear boundary conditions. Grounded in care ethics and relational autonomy, this article conceptualizes such practices as “benevolent coercion” and develops a Relational Legitimacy Framework (RLF). The RLF treats restrictive measures as normative actions that carry a burden of justification and requires that they meet, simultaneously, risk-grounded necessity and proportionality; relationally defined, minimally intrusive alternatives; relational procedural legitimacy, including the identification of false consent and the possibility of withdrawal; and non-negotiable baseline protections for dignity and privacy. It further emphasizes time-limited reassessment and viable exit mechanisms. The Chinese context serves as a setting in which underlying mechanisms become especially visible, allowing assessment of the risk that key conditions may fail in practice. This article contributes a reusable normative braking system for safety-based justifications and offers a theoretical foundation and practical guidance for nurses and institutions to integrate restrictive measures into actionable ethical decision-making procedures and governance rules.