Resolving Ethical Dilemmas in Community-Based Care

Abstract

There is consensus that our current system of delivering health care, with its institutional bias, fragmentation, excessive costs, and focus on acute care has not been a success for the frail elderly. Our standard ethics methods are equally unworkable: For the frail elderly living in the community, a standard principle approach to resolving ethical dilemmas is problematic and difficult to apply.

Although there are many similarities in the types of ethical issues encountered in acute care and in the community (e.g., conflicting goals of treatment, nonbeneficial treatment, and end-of-life issues), significant differences in the contextual circumstances limit the usefulness of the standard ethical frameworks. There are distinctions about the very old living in the community that require a new approach to ethics in order to illuminate their problems. Bioethics has tended to focus on grand events and dramatic decisions. However, away from the hospital, in the community, ethical issues affecting the elderly are more likely to be found in the daily routines of life.

When ethical challenges arise in the community, what is required is an approach to ethical case consultation that gives value to the many positive aspects of providing care there while recognizing that the duties of health care providers remain, even outside the institutional setting, and must be respected and upheld. This chapter describes and applies an alternative set of principles to use in resolving the ethical dilemmas encountered when providing health care to elders residing in the community.