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Ethical challenges related to elder care: high level decision-makers' experiences
University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
2007 (English)In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 8, no 3Article in journal (Refereed) Published
Abstract [en]

Background

Few empirical studies have been found that explore ethical challenges among persons in high public positions that are responsible for elder care. The aim of this paper was to illuminate the meaning of being in ethically difficult situations related to elder care as experienced by high level decision-makers.

Methods

A phenomenological-hermeneutic method was used to analyse the eighteen interviews conducted with political and civil servant high level decision-makers at the municipality and county council level from two counties in Sweden. The participants worked at a planning and control as well as executive level and had both budget and quality of elder care responsibilities.

Results

Both ethical dilemmas and the meaning of being in ethically difficult situations related to elder care were revealed. No differences were seen between the politicians and the civil servants. The ethical dilemmas mostly concerned dealings with extensive care needs and working with a limited budget. The dilemmas were associated with a lack of good care and a lack of agreement concerning care such as vulnerable patients in inappropriate care settings, weaknesses in medical support, dissimilar focuses between the caring systems, justness in the distribution of care and deficient information. Being in ethically difficult situations was challenging. Associated with them were experiences of being exposed, having to be strategic and living with feelings such as aloneness and loneliness, uncertainty, lack of confirmation, the risk of being threatened or becoming a scapegoat and difficult decision avoidance.

Conclusion

The high level decision-makers feel that something worthwhile is at stake in elder care. A risk exists that older adult and decision-maker needs are not being met. The results provide further insight into the ethical challenges and reasoning found among high level decision-makers, which are important since their decisions affect older patients, relatives and caregivers, and can be useful when conducting discussions within health care organisations. Future research is suggested on how people are affected when loyalties to a position come into conflict with personal convictions. Since ethical dilemmas that confront all levels of health care organisation will persist, the concept of organisational ethics also needs further research.

Place, publisher, year, edition, pages
2007. Vol. 8, no 3
Keywords [en]
Ethical challenges, elder care, high level decision-makers, politicians, civil servants, organisational ethics, phenomenological hermeneutics
Identifiers
URN: urn:nbn:se:hig:diva-2953DOI: 10.1186/1472-6939-8-3PubMedID: 17419880OAI: oai:DiVA.org:hig-2953DiVA, id: diva2:119615
Available from: 2007-11-27 Created: 2007-11-27 Last updated: 2018-03-13Bibliographically approved

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Mamhidir, Anna-Greta

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