Balancing Safety, Autonomy, and Dignity in Wartime: A Decision-Making Model for Social Workers Supporting Adults with Dementia in High-Risk Areas

Abstract Social workers play a crucial role in upholding the human rights of people with dementia, balancing their well-being and safety with the preservation of their autonomy and dignity. In times of war, this balance becomes even more challenging as considerations of protection and security may override these rights, leading to paternalistic interventions. This article examines an ethical dilemma that arises when individuals with dementia, living in high-risk areas, resist evacuation during war. To address this issue, we propose a decision-making model. Firstly, it emphasizes autonomy by considering the individual’s decision-making capacity, advance directives, and pre-dementia preferences. Secondly, it respects dignity by advocating for the fulfillment of their wishes even without decision-making capacity. Thirdly, the framework incorporates utilitarian considerations, prioritizing overall well-being and protection from harm. Fourthly, it accounts for legal variations across countries that may prioritize these principles differently. Finally, it considers relevant intervention methods for social workers. This model can serve as a practical tool for social workers to navigate such ethical dilemmas methodically. Furthermore, it can be adapted to address similar situations involving adults with dementia in the context of natural disasters and other crises.