Ethical Issues in Long Term Care

Ethical Issues in Long Term Care

Stacy Hamilton

HCA 333 Introduction to Long Term Care

Ms. Beth Madvin-Cox

July 28, 2013

Ethics refer to the moral aspects of human conduct and personal character. Often ethical dilemmas arise in relation to personal freedoms, responsibilities, and rights or obligations. This paper will discuss the topic of ethical issues in long term care settings as applied by the scientific method to analyze/evaluate the topic of ethical issues on long term care. One scientific method that is applied to making ethical decisions in situations for the patients in long term care settings is called Principlism. This paper will discuss Principlism, some ethical issues associated with long term care settings, and some ways to resolve these issues. According to Ensign (2004), "Ethics and morality are not equivalents. Although ethics is frequently the study of morals and, as such, is the study of what ought to happen, for the elderly and their healthcare providers, ethics can mean two different things."

Ethical issues in long term care are relevant because ethical issues are fundamental to any discussion or reflection on aging and health care. To provide the highest level of care, the entire caregiving team needs to develop a partnership having the best interest of the elder as their main focus point while providing loving, appropriate care to enhance their quality of care, their quality of life and their happiness in the latter days of their lives. For the elderly, ethics is about how they want to be treated and allowed to make their own decisions. For family members as caregivers, ethics is about doing what is right even when no one is looking. For professionals providing eldercare, ethics is about sticking to established rules of ethics published by organizations such as the American Medical Association for physicians, the American Nurses Association, and National Association of Social Workers (Ensign, 2004).

The reason ethical issues are important enough to conduct research is because the elderly are frail, easily taken advantage of, and are not treated as they deserve. The ethical issues related to everyday life in nursing homes and other long-term care facilities are extremely important. Historically, nursing homes have been had problems with abuse and neglect. It can happen. It is therefore essential that great care and attention is taken to these issues. Some ethical issues facing long term care are: autonomy, independence and self-worth, choices and decisions in daily life and well-being meaningfulness, quality care and living, advance care directives and living wills, advance care planning, right to privacy, religion and healthcare choices, abuse/neglect, informed consent, end of life treatment, confidentiality, and the use of restraints.

The people affected by ethical issues are the patients themselves, doctors, caregivers, physicians, and nurses, the patients' family, and others around the patients. If ethical issues are not addressed or mediated, it can cause unintentional harm or abuse, and the ethical issues can become legal issues for caregivers and/or physicians.

The dominant theory or model for medical or bioethics is called "Principlism." Although arose in the context of medicine, Principlism seems to be an appropriate framework for guidance in confronting ethical issues and making ethical decisions in situations elder caregivers of all kinds encounters (Ensign, 2004). Elaborating Principlism beyond its medical context, this scientific approach suggests that caregiving ethics begins, initially, with a determination of the condition, an understanding of the situation or a recognition of the problem or conflict, coupled with respect for patient autonomy, followed by the application of the essential principles of beneficence, nonmaleficence, and justice (loyalty and fairness) along with respect for the sanctity of the life of the one being cared for. Thus Principlism may be understood as a framework within which particular cases (issues or conflicts or moral problems) are analyzed and addressed to an appropriate conclusion. Principlism is not merely a set of "rules" per se "because prima facie principles do not contain sufficient content to address the nuances of many moral circumstances" (Ensign, 2004).

Principlism is embraced in the NASW Code of Ethics which states, "The Code offers a set of values, principles, and standards to guide decision making and conduct when ethical issues arise. It does not provide a set of rules that prescribe how social workers should act in all situations. Further, the NASW Code of Ethics does not specify which values, principles, and standards are most important and ought to outweigh others in instances when they conflict. Ethical decision making is a process."

Principlism, framework (when understood by all caregivers), can be helpful in ethical decision-making to benefit the elder and enhance their quality of life. This is especially true where the elder's capacity to make decisions or to consent to treatment is questionable. There are four main principles in the Principlism theory: 1.) autonomy (respect for the elders' choices), 2.) beneficence (do good), 2.) nonmaleficence (do no harm), and 4.) justice. And most important is the ultimate foundation for these principles-the sanctity of life. Ethical decision-making in the framework of Principlism is meaningless unless all members of the eldercare provider team apply them with diligence and consistency.

There are some opponents to the Principlism theory; Regis University states,

Although very influential in contemporary bioethics, principlism has been widely criticized on several counts. For example, because principlist approaches are not rooted in particular overarching values, there is no widely accepted standard for resolving the inevitable conflicts between principles. Individual principles may be interpreted or weighted differently by different individuals or may not accurately represent particular cultural viewpoints