Ethical Problems in End-of-Life Decisions for Elderly Norwegians

Abstract

Norwegian health professionals, elderly people and family members experience ethical problems involving end-of-life decision making for elders in the context of the values of Norwegian society. This study used ethical inquiry and qualitative methodology to conduct and analyze interviews carried out with 25 health professionals, six elderly people and five family members about the ethical problems they encountered in end-of-life decision making in Norway. All three participant groups experienced ethical problems involving the adequacy of health care for elderly Norwegians. Older people were concerned about being a burden to their families at the end of their life. However, health professionals wished to protect families from the burden of difficult decisions regarding health care for elderly parents at the end of life. Strategies are suggested for dialogue about end-of-life decisions and the integration of palliative care approaches into health care services for frail elderly people.

End-of-Life Care of the Geriatric Patient and Nurses’ Moral Distress

“…7 A lack of financial and personnel resources in care for the elderly as a source of moral problems has also been described in other studies. 20,31,32 Rees et al 17 stated that the ageist attitudes of health care organizations are responsible for this failure to adequately resource the care of older people.…”

“…17 Additionally, in taking care of the frail elderly, nurses are often confronted with patients at the end of their lives, 18 leaving them to struggle with questions such as the appropriateness of aggressive care. 19,20 To fill in this void, the purpose of this project was to explore MD in geriatric care. First, we aimed to explore which patient-related care situations are mostly causing MD.…”

Ethical problems related to intravenous fluids in nursing homes

“…[9][10][11] Relatives have also reported that the provision of information and interactions may be unsystematic and random, 12 while discussions with patients and their relatives about treatments often occur only when a patient becomes seriously ill. 9, 13 Schaffer 14 found that health professionals experienced the highest number of ethical problems during interactions with relatives as part of decision-making processes. Several studies have indicated that nurses experience ethical problems and dilemmas when relatives disagree about a treatment that has been approved 10, [14][15][16][17] and that nurses might be pressured into starting treatments to satisfy the family's needs. 10,11,14,15 An ethical problem involves uncertainty or disagreement about how a situation should be managed, which may arise if healthcare professionals do not advocate the patient's dignity or autonomy, or if they are disrespectful.…”

End-of-life expectations and experiences among nursing home patients and their relatives—A synthesis of qualitative studies

“…Family members often sense the forthcoming death of their loved one. If patients and their families have not discussed this matter, diverging expectations may emerge when the patients become ill and decisions about life-sustaining treatment have to be made [8,9]. Dialogues between staff members, patients and their relatives about the end of life are prerequisites for individual decision-making [10,11], but health professionals often experience this as being difficult [12,13].…”