Even as a lay person, not in the field of aging, other than being an older adult and in the process of aging, I found a recent Maryland Gerontological Association forum on "Ethical Issues in Practice with Older Adults" at Vantage House, in Columbia, both educational and enlightening. After a welcome by MGA president Virginia Thomas, of Columbia, Reba Cornman, MSW, Geriatrics and Gerontology Education and Research Program, University of Maryland Baltimore, introduced the speaker, saying that the presentation would provide a framework for approaching the special issues gerontologists face in working with older adults in a variety of settings.
The speaker was Barbara Soniat, MSW, PhD, who is an associate professor and director of the Center on Global Aging at the National Catholic School of Social Service at Catholic University in Washington, D.C. She has worked in the field of gerontology for over 30 years.
The audience was made up primarily of social workers, a few nurses, an occupational therapist and others, who are working in the areas of assisted living, hospice, medical day care, affordable housing/independent living for seniors, managed care and adult protective services. Continuing Education Units were given for those professionals who needed them.
Barbara provided some definitions in her handout that might be useful here. Ethics is a branch of philosophy that studies human conduct, with emphasis on the determination of right and wrong; just or unjust. Ethical dilemma is a situation in which one is unsure about what is right or what is good; or when there is a conflict between opposing moral systems or obligations (Abramson, M. 1985). Paternalism is overriding a person's wishes or actions for beneficent reasons, based on concern for the person's "own good." Justifiable Paternalism suggests that the overriding of a person's wishes or actions is justified if certain conditions exist. Abramson proposes the following conditions: The individual does not have the capacity to make and informed choice. A mentally incompetent person is unable to comprehend the possible consequences of an action. The consequences of not intervening may be far reaching and irreversible. And, Temporary interference with a person's liberty ensures future freedom.
There are different levels of ethical decision making and many variables to be considered in the process. Client cases aren't black and white but are often convoluted and extremely difficult, causing ethical dilemmas for the practitioner. There are so many different practice settings the older adult client may be in, such as living in their own home, with family, independent older adult communities or assisted living facilities; outpatient medical practices; inpatient-hospital settings; and nursing home settings. The aging population is very diverse and is continually changing, so decisions for clients may vary based on age (decision would be different for someone age 60 versus someone age 100); culture; socio-economic factors; and functional and mental health. All of these elements influence ethical decision making.
Barbara Soniat, who lives in Columbia, gave a personal example. She is originally from Louisiana, and her mother who still lives there has Alzheimer's. She is the only child in the family who went to college. When she goes home to take care of her mother, she looks for assisted living facilities for her. She found one but her siblings won't hear of their mother going into a facility. They will take care of her at home. Barbara said that she cannot be authoritative in this situation, lording it over her siblings with an "I know better" attitude based on her years in the field of aging. Barbara's daughter took a leave of absence from her job and she and her 8-year-old daughter moved to Louisiana to take care of her grandmother/great-grandmother. Barbara takes her turn in caring for her mother but this is not the care plan she would have ever chosen for her mother.