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Ethics in Long-Term Care

Live is full of gray areas, and our freedom as American citizens gives us the opportunity to make multiple choices every day.  As a person who has the tendency to think every question has a logical, linear, definable solution, I admit that gray areas are confounding to me sometimes.

I’m not indecisive, I’d rather just have some of life’s simpler choices made for me.  For example, I was taught as a child that dairy products are good for me, but now some say that isn’t true.  Hearing that white cheese is better for me than yellow cheese, or that goat cheese is the answer just makes me tired.  Could we just settle the issue once and for all?

It seems to me that healthcare decisions often fall into gray areas, but when human lives are at issue, I think the consideration of ethics is important.  When a 99-year old person can benefit from surgery by gaining mobility, there are risks, so a surgeon must decide whether to advise the patient to have the procedure.  When that advice is given, should the ethics of financial compensation come into play?  I’d argue that it should.  Much of healthcare reform revolves around compensation of providers for services, as opposed to compensation based on outcomes.

In long-term care, we can on one extreme create a surplus of safety that limits the independence of the individual.  On the other extreme, financial concerns can result in poor outcomes when facilities are too under-staffed to provide the level of care the residents require.

Measuring a healthcare provider’s ethics is difficult work in a world of gray, relativistic thinking where “good” is often defined is “not as bad as the others.”  However, even in the gray areas there are bright line standards that should not be crossed.  You can make good decisions by looking at the company a person keeps, by looking at past performance as a predictor of future outcomes, and by asking probing, open-ended questions about the provider’s propensity to take unnecessary risks in providing care.
If you are in the position of evaluating long-term care providers, don’t shy away from the “E” word.  Ethics still matter to the health and well-being of your loved one.

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