Anna-Greta Mamhidir1, Mona Kihlgren* 1,2 and Venke Sorlie* 2,3
1Department of Neurobiology, Caring Sciences and Society, Karolinska Institute, Stockholm, Sweden
2Centre for Nursing Science, Örebro University Hospital, Örebro, Sweden
3Bodo University College, School of professional studies, Center for Practical Knowledge, Norway
BMC Medical Ethics 2007,
8:3. This is an Open Access article distributed under the terms of the Creative Commons Attribution License
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.
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.
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.
Our paper provides further insight into the ethical dilemmas and
ethical challenges met by high level decision-makers', which is
important since the overall responsibility for elder care that is also
ethically defensible rests with them. They have power and their
decisions affect many stakeholders in elder care. Our results can be
used to stimulate discussions between high level decision-makers and
health care professionals concerning ways of dealing with ethical
issues and the necessity of structures that facilitate dealing with
them. Even if the high level decision-makers have learned to live with
the ethical challenges that confronted them, it was obvious that they
were not free from feelings of uncertainty, frustration and loneliness.
Vulnerability was revealed regarding themselves and others. Their
feelings of failure indicated that they felt something was at stake for
the older adults in elder care and for themselves as well, in that
there was the risk that important needs would go unmet.