HLTH 4303 Module 5 In-Room Camera Ethical Dilemma Analysis Example

A Camera on the Dresser: Weighing a Family's Request to Monitor a Resident's Room by Video at a Skilled Nursing Facility

Student Name

American College of Education

HLTH4303: Legal and Ethical Issues in Healthcare Administration

Module 5 Assignment

Instructor Name

November 2, 2026

The Request

The daughter of Mr. R., who lives at our composite skilled nursing facility, is 79 and has had a stroke and has limited speech, has asked to install a small video camera on the dresser in his room. She says her father has come home from therapy upset twice in the past month, has a bruise on his forearm that nobody could explain, and cannot tell her what happens when she is not there. She wants to watch the camera's feed on her phone. Mr. R. shares his room with another resident, Mr. P., who has moderate dementia and whose son is his representative.

The request raises legal questions, but it is first an ethical dilemma. Protecting a vulnerable resident from possible harm is a strong reason to allow the camera. Privacy and dignity, for Mr. R. himself, for his roommate and for the staff who care for them, are strong reasons for caution. The facility cannot simply say yes or no without weighing both.

What the Research Says

Cameras in resident rooms have spread quickly as inexpensive internet-connected devices have become common, and several states now regulate them. Berridge et al. (2019), drawing on the first facility survey on the subject, noted that seven states had laws regulating camera monitoring at the time and identified three ethical issues: the risk cameras pose to residents' privacy and dignity, the risk of undermining care workers' sense of themselves as trusted caregivers for residents, and the likely extension of camera use by facilities to monitor staff and residents for their own purposes. They argue that the safety benefits of cameras must be weighed against these risks rather than assumed to outweigh them.

Our state, like several others, permits a resident or representative to install an authorized electronic monitoring device in the resident's room, provided the facility is notified, a roommate or the roommate's representative consents in writing, and a sign at the room entrance discloses the camera. Those rules settle whether the camera may be installed. They do not settle whether it is the right response to the daughter's concerns, or how the facility should handle it.

Applying the Four Principles

The analysis is organized around the principles Beauchamp and Childress set out for biomedical ethics (Beauchamp & Childress, 2019), taken one at a time. Respect for autonomy asks what Mr. R. wants. He has limited speech but can answer yes-or-no questions reliably, according to his speech therapist. His own wishes should be sought directly, with his daughter present, before anything else. If he does not want a camera watching him bathe and dress, his daughter's worry does not override him. If he wants the camera, his wish carries weight too, and the facility should not refuse simply because cameras are inconvenient for staff. Asking him is also a way of treating him as the person at the center of the decision rather than as the subject of an argument between his family and the facility.

Beneficence and nonmaleficence point in two directions. A camera may deter or reveal mistreatment, which would protect him. It may also harm him by exposing intimate care to anyone who sees the feed, and a phone app can be viewed, recorded or shared far beyond his daughter. For Mr. P., the roommate, the camera offers no benefit and a real loss of privacy, since he would be filmed in his own room; his son's written consent is required by law, and if it is refused, the camera cannot be placed where it records Mr. P.

Justice asks whether residents are treated fairly. Families who can afford cameras and monitor them may get more attentive care than residents without such families, and staff who know they are filmed in one room may behave differently in the next. A camera can protect one resident while quietly teaching the building that only watched residents are safe.

The Concern Behind the Request

The daughter's request is a response to an unexplained bruise and her father's distress, and the facility has obligations about both that do not depend on the camera. An injury of unknown origin must be investigated, and under the federal requirements for long-term care facilities, an allegation or suspicion of abuse or neglect must be reported promptly to the administrator and state authorities, the resident must be protected during the investigation, and the results must be reported within set time frames (Requirements for Long Term Care Facilities, 2024). These duties exist precisely because residents like Mr. R. often cannot report mistreatment themselves, which is the same reason his daughter wants a camera. The facility should begin that investigation now: review the therapy schedule and staff assignments on the days in question, examine his transfers and the equipment used, and interview staff. If the bruise came from a wheelchair armrest during transfers, the fix is different from the fix for rough handling, and both are the facility's responsibility whether or not a camera is installed.

Decision

The facility should respond in three steps. First, investigate the bruise and the episodes of distress immediately and report the findings to the daughter within ten days, involving the state agency if abuse is suspected. Second, ask Mr. R., with his daughter present and his speech therapist supporting communication, whether he wants a camera. Third, if he agrees and Mr. P.'s representative consents, allow the camera under a written agreement: the camera will be positioned to avoid the roommate's side of the room, the daughter will turn it off or cover it during bathing and dressing, recordings will not be shared or posted, and the arrangement will be reviewed in three months. If Mr. P.'s representative declines, the facility should offer Mr. R. a move to a private or differently shared room so that a camera can be used without filming another resident.

The facility should not use the daughter's camera to monitor its own staff, and it should tell staff honestly that the camera is there and why. Berridge et al. (2019) warn that cameras can erode care workers' sense of themselves as trusted caregivers; being open about the camera, and pairing it with the investigation rather than using it as a substitute, is the best way to limit that harm.

Policy for the Next Request

This will not be the last request. The facility should adopt a written electronic monitoring policy covering the state's legal conditions, the process for seeking the resident's own wishes, roommate consent, camera placement, privacy during personal care, data handling, signage and review. It should also commit to a response for any family who raises a concern about care, whether or not they want a camera, because the most common reason families install cameras is that they do not trust the answers they receive. A facility that investigates concerns quickly and shares what it finds will receive fewer camera requests, and the requests it receives will be easier to handle well.

References

Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.

Berridge, C., Halpern, J., & Levy, K. (2019). Cameras on beds: The ethics of surveillance in nursing home rooms. AJOB Empirical Bioethics, 10(1), 55-62. https://doi.org/10.1080/23294515.2019.1568320

Requirements for Long Term Care Facilities, 42 C.F.R. pt. 483, subpt. B (2024).