Exploring Ethics, Relationality and Justice in the Context of Resident-to-Resident Aggression in Nursing Homes

Resident-to-resident aggression (RRA) is highly prevalent in long-term care settings. RRA is most commonly attributed to the characteristics of aberrant individuals living with dementia, captured by popular and empirical accounts in the representation of the ‘violent resident’. Consequently, current prevention efforts focus on curtailing the actions of residents identified as “aggressive”. This neglects that acts of aggression are influenced by broader social and physical environments. It is our argument that this reductionism can be traced to the biomedical ethic that underpins dementia care. Biomedical ethics are too narrow an approach to guide decision-making in the context of RRA. There is a need to engage broader discourse in political philosophy and philosophy of ethics to develop an alternative ethic to guide prevention efforts. To this end, we critically review the work of Nussbaum and Nedelsky, drawing on their strengths and identifying their limitations. With an interest in addressing these limitations we explicate an alternative ethic that is grounded in a model of citizenship that recognizes relationality and the agential status of embodied self-expression. The application of this ethic offers a more holistic prevention strategy by drawing attention to the systemic underpinnings of aggression and the critical need to promote human flourishing.