Guardianships and older adults from the perspective of dignity

Abstract

Alzheimer’s disease is the most common form of dementia, classified under major neurocognitive disorder. According to Alzheimer Europe’s 2025 report, an estimated 9,476 people in Malta are living with dementia, and this number is expected to double by 2050. As the disease progresses, individuals may experience severe cognitive decline, affecting their ability to carry out daily tasks and make important healthcare decisions. In such cases, guardianship may be introduced to support decision-making. Guardianship refers to the legal relationship between a guardian and a person unable to manage their own affairs due to mental or physical incapacity. Despite its protective role, guardianship may threaten the dignity and autonomy of older adults when applied in a paternalistic manner within Maltese healthcare settings. This creates an ethical dilemma: balancing the protection of vulnerable individuals with respect for their autonomy and dignity. This dissertation critically examines Maltese guardianship law and explores how it may either support or undermine the dignity and autonomy of older adults under guardianship. The study addresses two main questions: Do guardianships in Malta adequately protect the dignity and autonomy of older adults in practice? If not, how can guardianship be reformed to better safeguard both? The study adopts a bibliographic approach using secondary sources, including peer reviewed articles, books, policy documents, medical society publications, and legal texts. Some anecdotal experiences observed by the researcher are also included. The dissertation is divided into three chapters: the first examines Maltese guardianship law and its ethical implications; the second explores the philosophical concepts of dignity and autonomy; and the third proposes recommendations for reform. Ultimately, this research aims to promote ethical discussion surrounding guardianship and raise awareness of the challenges it presents, while offering recommendations to better protect the human rights, dignity, and autonomy of older adults in healthcare decision-making.