Instructor Mr. Curl
21 October 2009
ETHICAL CHALLENGES FOR THE ELDERLY
When patient problems arise in the nursing profession, our knowledge and education usually help us find the obvious and correct solution. There are, however, situations that arise where the correct choice is not readily apparent. These situations are difficult enough to handle when the patient is young and able to understand what’s going. As the patient ages, she’s less able to assist in the decision making process and the decision making responsibility shifts onto the nurse’s shoulders. The resulting doubt and stress can adversely affect the nurse for a prolonged period of time. Unless and until we understand the unique challenges presented when caring for elderly patients we can’t be comfortable with our profession. In the next 25 years, the number of persons over 65 years of age will increase from 40 million to 70 million. In the year 2030, 1 out of 5 people will be over 65. As a nurse, we can’t afford not to learn about the specific challenges that face us when attending to the elderly. When our education and the knowledge we’ve gained throughout life doesn’t provide us with the one correct answer, we need a way to pick the best of alternative answers. When the questions have serious immediate and long term consequences, finding the best answer becomes very important. This is where ethics comes into play. Ethics is a set of moral principals, a code for behavior. It provides us with a rational process for determining the best course of action in the face of conflicting choices. If we can’t find the one correct answer at least the answer we find is consistent and coherent. This is often the best we can expect. When we are faced with serious questions that have no answers we are confronted with an ethical dilemma. We desperately want to do the right thing, but we’re not sure of the correct answer. When dealing with the elderly we are faced with many ethical dilemmas. The cost of legal care is sometimes prohibitive and it’s only going to get worse. The elderly do not always have the resources or insurance coverage to pay for the medication and procedures that they require. Similarly, the needed treatment is not always available where the patient lives or there is a shortage in needed nurses. Today we live longer on average than our parents. In the past, we were only concerned with treating the patient and making them well. Now we have questions where we have to weigh the longevity of a patient against her quality of life. Living as long as possible is not always the goal or desire of the patient. As the patient gets older, she’s less able to decide for herself. As a result, the family feels compelled to make some of the decisions. Very often the wishes of family members do not coincide with the wishes of the patient or even other member of the family. The nurse needs to be a facilitator in these situations. Many of the dilemmas facing the elderly have religious or cultural aspects. Without knowledge of the Jewish or Muslim faiths, for example, a nurse cannot possibly understand what challenges face a terminal patient of one of those faiths. As a person ages a degree of dementia sets in. How is it possible for a nurse to intelligently discuss topics such as organ donation with a patient that doesn’t know where she is? When faced with these and other ethical dilemmas, it is necessary for the nurse to have tools that help her arrive at a decision she can live with. What follows is a discussion of certain resources that a nurse can turn to for assistance. The American Nurses Association has established a Code of Ethics to provide a basis for difficult decisions. Provision 1 provides that: “The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and...