善意何以成为困境：独居老人照护中保护与控制的伦理分析

When Good Intentions Become Ethical Dilemmas: An Ethical Analysis of Protection and Control in the Care of Elderly People Living Alone

摘要: 在我国深度老龄化背景下，高龄独居老人的生活自主与安全保障之间的矛盾日益突出。文章以W社区一起87岁独居老人电动轮椅被子女蓄意破坏的典型事件为经验材料，综合运用生命伦理学四原则理论、家长主义批判理论与能力方法，从老年人自主权、家庭保护性干预的合理限度、尊严维护及社区介入边界四个方面展开分析。研究发现，老年人、家庭与社区三方在自主性、安全性与责任归属上存在明显冲突，家庭照护中的“善意控制”构成对老年人主体性的明显削弱，而社区也在制度授权与现实回应之间面临两难。在此基础上，本文从尊重并支持老年人自主权、构建家庭照护协商机制、厘清社区服务职责边界、推进适老化环境建设及强化社会支持网络五个方面提出干预路径。

Abstract: Against the backdrop of China’s deepening population aging, the contradiction between life autonomy and safety protection for elderly people living alone has become increasingly prominent. Drawing on a typical case in W Community, where the electric wheelchair of an 87-year-old elderly resident living alone was deliberately damaged by his adult children, this study employs the four principles of biomedical ethics, critical theory of paternalism, and the capability approach to analyze the case from four aspects: the autonomy of older adults, the reasonable limits of family protective intervention, the preservation of dignity, and the boundaries of community involvement. The findings reveal clear conflicts among the elderly individual, family members, and community workers regarding autonomy, safety, and accountability. The “well-intentioned control” embedded in family caregiving constitutes a noticeable weakening of the older adult’s agency, while the community faces a dilemma between institutional mandate and practical response. Based on these findings, this paper proposes intervention strategies in five respects: respecting and supporting the autonomy of older adults, establishing family care negotiation mechanisms, clarifying the boundaries of community service responsibilities, promoting age-friendly environmental improvements, and strengthening social support networks.