Autonomy or paternalism? Tensions in healthcare decision-making for older adults in Chile

The rapid aging of the Chilean population has led to a significant increase in physician-patient interactions. These interactions are legally complex, creating major challenges regarding capacity, autonomy, consent, and the effective protection of rights. Against this backdrop, this study focuses on a specific aspect of healthcare issues: decision-making by older patients within the context of standardized or institutionalized contractual practices for care services. It uses the contracts employed by “Establecimientos de Larga Estadía para Adultos Mayores” (Long-term care facilities for older adults) or ELEAM as a paradigmatic case study. Specifically, it examines the requirement for a third party to appear as a “designated representative” and the powers granted to them regarding decisions that directly affect the resident’s personal sphere—as a form of violence against older adults.