Ethical challenges related to elder care. High level decision-makers' experiences

Area of Science:

• Gerontology
• Public Health Policy
• Bioethics

Background:

• Limited empirical research exists on ethical challenges faced by public officials responsible for elder care.
• High-level decision-makers grapple with ethically difficult situations in elder care provision.

Purpose of the Study:

• To illuminate the lived experiences of high-level decision-makers in ethically challenging elder care situations.
• To understand the meaning and impact of ethical dilemmas in elder care from a decision-maker perspective.

Main Methods:

• Phenomenological-hermeneutic method employed for data analysis.
• Eighteen in-depth interviews conducted with political and civil servant decision-makers at municipal and county council levels in Sweden.
• Participants held planning, control, and executive roles with budget and quality responsibilities for elder care.

Main Results:

• Ethical dilemmas frequently arose from extensive care needs conflicting with limited budgets.
• Dilemmas included issues of inadequate care, patient vulnerability, insufficient medical support, and inequitable resource distribution.
• Decision-makers experienced exposure, strategic maneuvering, isolation, uncertainty, and avoidance of difficult decisions.

Conclusions:

• High-level decision-makers face significant ethical challenges impacting elder care quality and defensibility.
• Findings underscore the need for enhanced dialogue and structural support for decision-makers managing ethical complexities in elder care.
• Decision-makers reported persistent feelings of uncertainty, frustration, and loneliness, indicating vulnerability and potential failure in meeting elder care needs.