Abuse is abuse. Ability to escape is what’s important.

A few weeks ago Fintan O’Toole of the Irish Times wrote an article about old people being neglected and abused in a for-profit nursing home.  I wrote about it at the time.

Basically he asserted that privately owned for-profit homes were evil but that we were all under the spell of profit just as we’d been under the spell of the Catholic Church in the past.

It’s a nice narrative, but it’s hard to agree, particularly when we see what was going on in the UK with Jimmy Saville and a range of state run institutions.

A key element that’s required in order to reduce abuse is choice. Choice for the customer, or the patient, implies freedom to escape from an abusive home or orphanage or hospital. Even if someone is incapable of exercising choice themselves, there should be a legal guardian who can do it on their behalf. And that guardian should be someone whose ONLY interest is their ward and who has NO interest in the welfare of the home or hospital.

Problems arise when choice is not allowed, or even where the abusive organisation is also the legal guardian.  That’s terrifyingly common in state run or state mandated care.  Whether at the Christian Brothers or the Sisters of Mercy or an Industrial School, the abuse victims couldn’t leave. Their wishes were explicitly not important.

As this article shows, abusers are inclined to flock together. If the kids or the old people had been able to ask to be moved, perhaps the abuse would have been avoided. Or at least the scale might have been less.

In some ways it doesn’t matter whether the service provider (hospital, home) is state owned or privately owned. As long as the customer or the patient has choice and there is real competition then abuse will be hard to maintain.

Abusers focus on the powerless and the friendless. Instead, we could give the patient/customer the power to choose. I suspect they’d choose to leave institutions that abused them. That’d be progress.


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