Ethics support in institutional elderly care: a review of the literature

Abstract

Clinical ethics support mechanisms in healthcare are increasing but little is known about the specific developments in elderly care. The aim of this paper is to present a systematic literature review on the characteristics of existing ethics support mechanisms in institutional elderly care. A review was performed in three electronic databases (Pubmed, CINAHL/PsycINFO, Ethxweb). Sixty papers were included in the review. The ethics support mechanisms are classified in four categories: 'institutional bodies' (ethics committee and consultation team); 'frameworks' (analytical tools to assist care professionals); 'educational programmes and moral case deliberation'; and 'written documents and policies'. For each category the goals, methods and ways of organising are described. Ethics support often serves several goals and can be targeted at various levels: case, professional or organisation. Over the past decades a number of changes have taken place in the development of ethics support in elderly care. Considering the goals, ethics support has become more outreaching and proactive, aiming to qualify professionals to integrate ethics in daily care processes. The approaches in clinical ethics support have become more diverse, more focused on everyday ethical issues and better adapted to the concrete learning style of the nursing staff. Ethics support has become less centrally organised and more connected to local contexts and primary process within the organisation.

The Norwegian national project for ethics support in community health and care services

“…within nursing homes, home care services, local public health centres and among general practitioners) has been much sparser than within hospitals and other specialized medical care [9, 10]. This is surprising since there is little reason to believe that the need is any less in community services [9, 11–13].…”

“…Van der Dam et al reviewed the literature on ethics support in institutional elderly care and identified 60 papers [10]. The earliest studies were from North America, due to the fact that ethics support was first developed there; several European countries are represented among the newer studies.…”

“…The review identified four categories of ethics support mechanisms: institutional bodies, such as ethics committees; analytical tools to assist professionals; educational programs and moral case deliberation; and written documents and policies. The authors conclude that ethics support has gradually become ‘more outreaching and proactive, aiming to qualify professionals to integrate ethics in daily care processes [10]. ’ Furthermore, ‘[t]he approaches in clinical ethics support have become more diverse, more focused on everyday ethical issues and better adapted to the concrete learning style of the nursing staff’ [10].…”

“…The authors conclude that ethics support has gradually become ‘more outreaching and proactive, aiming to qualify professionals to integrate ethics in daily care processes [10]. ’ Furthermore, ‘[t]he approaches in clinical ethics support have become more diverse, more focused on everyday ethical issues and better adapted to the concrete learning style of the nursing staff’ [10]. …”

Dylematy etyczne w pielęgniarstwie geriatrycznym — wybrane zagadnienia

“…Opieka świadczona według najlepszej wiedzy medycznej i przy użyciu najnowszych technologii i środków nie może być praktykowana w oderwaniu od zasad etyki [1,2]. Kwestie etyczne związane z opieką geriatryczną wiążą się z zagadnieniami demograficznymi (starzenie się populacji), społeczno-kulturowymi (postawy, uprzedzenia) i polityczno-organizacyjnymi (organizacja systemów opieki i obowiązujące w niej zasady) [3,4]. Dylematy etyczne w opiece geriatrycznej często pojawiają się także na skutek konfliktu między zobowiązaniami wypływającymi z roli zawodowej profesjonalisty i związanymi z nią obowiązkami prawnymi i etycznymi a autonomią i prawem do samostanowienia pacjenta [5][6][7].…”