GPS Wristbands in a Dementia Care Unit
Waitematā Views is a 42-bed aged-care facility. Fourteen residents have moderate dementia; two have exited the building in the last six months, and one was found 600 m away on a state highway before police returned her. The clinical manager proposes GPS-enabled wristbands for all dementia-level residents. The wristbands cost $18 per resident per week, alert staff when a resident crosses a geofence, and record location continuously. The facility has 0.6 registered nurses per ten residents on night shift, below the recommended 0.8. Family opinion is split: four families have given written consent, two say the device is 'a leash', and eight residents cannot give consent. The vendor offers a three-month trial at a 10% discount if the facility signs before 30 June. The board wants a decision at its next meeting. The facility serves a mix of Pākehā and Māori whānau; one whānau has asked how the device respects their kuia's mana.
1. Identify the central ethical issue and analyse it using two ethical principles. Explain how the principles conflict in this situation.
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Central issue. The facility must decide whether to use continuous GPS monitoring for residents who cannot consent, in order to prevent serious harm. This is not simply a technology choice; it allocates risk and control between residents, whānau, staff and the organisation.
Beneficence and non-maleficence. The strongest argument for the wristbands is beneficence: two exits and one road incident show a real risk of serious harm. A device that alerts staff at a geofence could shorten search time and prevent injury. But non-maleficence also matters: continuous tracking can cause distress, stigma and a false sense of safety if night staffing is only 0.6 RNs per ten residents. A wristband does not physically stop a resident leaving; it may simply document the exit. If staff cannot respond, the device may not reduce harm.
Autonomy and privacy. Eight residents cannot consent, and two families object. For people with dementia, autonomy is not all-or-nothing. The ethical test is whether the resident's known values and prior wishes are respected, and whether the least restrictive option is used. Continuous location data is sensitive; it reveals movement, toileting patterns and visitors. Who can access it, how long it is kept, and whether it is shared with police or family must be specified.
Conflict. The principles conflict because protecting a resident from traffic danger may require overriding their present objection to being tracked. The conflict is resolved by asking whether the restriction is necessary, proportionate and reviewed, not by choosing safety over autonomy every time.
2. Evaluate the proposal against the principle of least restrictive alternative and Te Tiriti o Waitangi obligations. Recommend a justified course of action.
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Least restrictive alternative. Before GPS, the facility should trial environmental and staffing controls: door sensors, a secure garden, individual wander-risk assessment, activity programmes at dusk, and a night supervision plan. GPS should be used only for residents with an assessed exit risk, after a best-interests process, with a trial and review date. A blanket rollout to all 14 residents is not the least restrictive option.
Te Tiriti o Waitangi. The board must actively partner with Māori whānau, not just consult. That means resourcing whānau hui, hearing concerns about mana and tapu, and sharing decision-making about how a kuia is monitored. Cultural safety also requires that the device does not substitute for culturally appropriate care, such as whānau presence or kaumātua support. Data governance should be co-designed, and whānau should know who sees location data.
Recommendation. Do not sign the vendor discount before 30 June. Approve a six-month trial for residents with an assessed exit risk, with written informed consent where possible and a whānau/best-interests process where not. Fund door sensors, a night supervision review and a quiet activity programme first. Set evaluation measures: exits, falls, distress, staff response times, whānau satisfaction and data access incidents. Review with the board, whānau and iwi partners before permanent purchase.