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There are a great number of ethical challenges that can impact decision-making processes in healthcare. Taking into account that various social groups are not equally protected and have different health needs, making healthcare for older adults more ethical remains a high-priority task. In this connection, an important question refers to the economic consequences of the inability to adapt healthcare policy to older patients’ changing needs. As Hayutin, Dietz, and Mitchell (2010) note, life expectancy in the United States continues to rise, whereas older citizens still spend large sums of money on healthcare services. The extensive (and sometimes unnecessary) use of healthcare services is related to the lack of self-care. If the trend indicated by the authors continues to grow, today’s taxpayers will have to pay even more.
In this situation, dispersing limited funds to provide citizens of advanced age with high-quality services involves making numerous ethical decisions to align with the principle of fairness. Ethical decisions include the necessity to determine the most vulnerable groups of patients of advanced age, paying attention to their current health status, family composition, and other factors. Another important ethical problem relates to the necessity to reduce the share of unnecessary medical visits. It is common knowledge that older adults become more sensitive to loneliness. To some extent, the ability to communicate with healthcare providers is seen as a salvatory measure. Thus, encouraging older patients to come only with urgent health issues can somehow pose a threat to their psychological health.
To prevent the deterioration of healthcare services, it is pivotal to define the key ethical standards to be used in making decisions on the allocation of healthcare resources for older patients and end-of-life care. Personally, I believe that the principles to guide decision-making in healthcare for the aging population should include fairness, necessity, patient well-being, and urgency. Focusing on these standards, it will be necessary to make changes to the currently used social criteria that define the categories of people who need help first (Craig, 2010).
Significant ethical dilemmas also arise when it is necessary to determine the number of resources to be used to provide end-of-life healthcare. Even though the available resources are becoming more limited, EOL expenditures need to be increased since racial (and sometimes religious) inequality still impacts the distribution of services in this sphere. For instance, it is known that racial minorities in the United States underutilize end-of-life services, partially due to the lack of trust in healthcare providers (Elk, 2017). The lack of equality can be considered as an important ethical problem to be solved; for instance, changing the situation may require more resources to provide education on cultural differences to healthcare providers. The principle of equality should also be considered when assessing the ethicality of new policies since evaluations “cannot be culture free” (Milstead, 2016, p. 206). Therefore, all ethnic groups should be represented in evaluation committees.
The above-mentioned ethical standards can be extremely difficult to implement because the ability to provide such healthcare is inextricably connected with ethical challenges. First, the use of these principles is complicated due to the necessity to sort out priorities when providing services to people who belong to different age groups. For instance, even though children have more opportunities to contribute to society in the future than people of advanced age, the use of the “effectiveness” considerations in funding healthcare is ethically inappropriate. Other challenges that should be taken into account to successfully implement these principles include the necessity to strike the right balance between equality and special needs. Also, to prepare for the provision of such care and implement the principle of well-being, it can be important to reconceptualize the urgency of mental healthcare for older adults, which is often underestimated.
Craig, H. D. (2010). Caring enough to provide healthcare: An organizational framework for the ethical delivery of healthcare among aging patients. International Journal for Human Caring, 14(4), 27–30.
Elk, R. (2017). The need for culturally-based palliative care programs for African American patients at end-of-life. Journal of Family Strengths, 17(1), 1-4.
Hayutin, A. M., Dietz, M., & Mitchell, L. (2010). New realities of an older America: challenges, changes and questions. Stanford, CA: Stanford Center on Longevity.
Milstead, J. A. (2016). Health policy and politics: A nurse’s guide (5th ed.). Burlington, MA: Jones and Bartlett Publishers.