Older Adults

Ethical Issues

Ethics refer to the moral aspects of human conduct and personal character. Often ethical dilemmas arise in relation to personal freedoms, responsibilities, and rights or obligations. To help older adults and their loved ones work through ethical dilemmas, the University of Pittsburgh Institute on Aging, in partnership with the University of Pittsburgh Center for Bioethics, identifies and offers insight into some common situations in which ethical issues may arise.

advance care planning: Advance care planning involves advance preparation for life’s unexpected emergencies. Regardless of age, advance care planning provides greater control over decisions that affect a person’s future and takes into consideration the person’s beliefs and preferences in the event they are unable to make decisions on their own.
health care: Health care ethics, often referred to as “medical ethics,” relate to issues of privacy, confidentiality, and informed consent as well as the courses of action involved in making medical decisions.
family and friends: Whether a person is very close with his or her family or has not spoken with them in years, family members often become involved in the care of a sick family member. You may be uncomfortable talking with loved ones about your care and treatment preferences, or you may believe your medical information should not be shared with anyone.
right to privacy: Medical treatment often involves sensitive subjects that we would rather not share with other people — even those who are very close to us. If you are receiving treatment, and you do not want information shared with family, friends, or anyone else, you should know that knowledge is kept private between you and your health care team.
religion and health care: Religion may be a very important part of your life. If so, your religious beliefs may influence the types of medical treatment you desire. It is crucial to know your religion’s true beliefs about certain medical procedures. Many times, even the most devout people are unclear about some of their religion’s rules. They may refuse medical treatment that is allowed by their faith or consent to medical treatment that is not permitted.

FAQs About Ethical Issues

Following are some frequently asked questions and answers about common ethical issues:

Q: When I can no longer make treatment decisions myself, I am afraid I won’t get the treatment I want or will receive treatment that I do not want. How can I make sure my wishes are followed?

A: Plan ahead for life’s unexpected emergencies:

Discuss with your doctor, family members, and friends, different medical scenarios that might arise, and help them to understand your preferences for treatment and medical care. Share with them both your preferences and values.
Explain your preferences in writing. Complete an advance directive – a living will or a durable power of attorney for health care. Give copies to your doctor, local hospital, and family members or friends.

A living will is a document that specifies what you want and do not want if you are in a certain condition, such as a persistent vegetative state, for example. A medical power of attorney (also known as a “durable power of attorney for health care”) is a document that appoints someone you trust to make health care decisions for you when you are not able to do so.

Q: What should I do if I have an ethical issue of conflict in the course of medical care, home care, or long-term care?

A: The best ways to resolve ethical conflicts are to:

Discuss the issue of concern with the people involved: doctors, nurses, social workers, family.
Request a meeting to develop a plan on which everyone can agree.
Ask for an ethics consult (a meeting with the ethics committee).

An ethics consult is a meeting between a patient, family member, or a member of the health care team and an established committee of ethical consultants to discuss ethical issues.

At most hospitals and long-term care facilities, ethics committees are comprised of individuals with both experience in the clinical care environment and in resolving ethical issues that arise in the facility. These individuals understand both hospital policies and patient rights. They help to clarify issues and make recommendations.

Q: My doctor and family are recommending a medical procedure, but I’m not sure I want to go ahead with it. Do I have a right to more information?

A: Yes, you have the right to all the information that is needed to make a sound and informed decision. If you have questions, it is a good idea to write them down and discuss them with your doctor.

Q: When my family and I disagree about my medical treatment, whose preferences determine my care?

A: So long as you are capable of making decisions on your own, you have the right to make all of the decisions regarding your medical treatment. Of course, discussing your preferences with your family and doctor in advance helps to avoid differences in opinion when care is needed.

Q: Do I have the right to refuse treatment?

A: Yes. As the patient you have the right to refuse any course of treatment you do not want or with which you are not comfortable. However, you may want to obtain a second opinion from a different doctor before deciding to refuse the suggested course of care.

If you are afraid that in the future, you will be unable to speak for yourself to direct your course of treatment, you should plan ahead by talking to your doctor, your family, and/or your friends about the types of treatment(s) you do or do not want.

You may also sign an advance directive (a document that outlines what type of treatment you want and do not want) or designate a surrogate decisionmaker (a person you trust to make decisions for you, based on what you would want, in case you can not make those decisions yourself).

Q: What does it mean to have informed consent? Why is it important?

A: As a patient, you will face decisions about your health care that will require your consent or refusal. Your doctor is obligated by law to fully inform you of your condition, your treatment options, and the benefits and consequences of those options so that you have the knowledge to allow for informed choice.

In a good doctor-patient relationship, you and your doctor decide together on the desired course of treatment. Informed consent means that you agree to a course of treatment based on the information provided by your physician or another member of your health care team. By ensuring that you are aware of the advantages and disadvantages of the various treatment options, you are able to participate fully in your health care decisions.

If you feel you do not have enough information to make a decision, ask questions about your options. If you are not comfortable asking your doctor or are not satisfied that your doctor has provided enough information, talk to another health care professional with whom you feel comfortable talking, like your nurse.

Q: What is decisional capacity?

A: Decisional capacity is the understanding needed to make a particular decision. Health care patients have decisional capacity when they are able to understand risks, benefits, and treatment options, and are able to think about and decide what to do in a particular situation.

Q: Although I want to make sure I am taken care of and receive good care as I age, I want to avoid becoming a burden on my family. Who could help me plan for my future to avoid becoming a burden?

A: Unfortunately, there are no easy answers to this question. Each individual and family is unique and must find the most appropriate balance to suit their situation and needs. Advance planning can help. Talk with everyone involved: your family, religious advisor, doctor, nurse, and social worker.

Q: I do not want my family to be informed about my health condition. What should I do to make sure my wishes are followed?

A: Inform your doctor and hospital of your wishes to prevent them from assuming you want your family to be informed. Ask them not to share any details about your condition with anyone without your permission.

Q: If I do not have family living near me, or I am not close to anyone in my family, can a close friend or significant other make decisions for me in the event I cannot make them myself?

A: Yes. To identify a friend as your decision maker, complete a durable power of attorney for health care. This document, officially recognized by health care facilities, allows the person you designate to make decisions regarding your care when you are no longer able to decide for yourself.

Q: I want to make sure my family and religious community are informed about my health. What should I do?

A: Request from your doctor or hospital a form on which you may identify the people whom you would like to receive information about your condition. Also, if you would like your name mentioned in the congregational announcement for prayers you should inform the minister of your religious community.

Q: Why is privacy important?

A: Privacy is important because medical information is often very personal and sensitive. Sharing your medical information may not only affect how other people think of you, but it may influence your insurance coverage, employment, and benefits.

Q: What is confidentiality and why is it important?

A: Hospitals and health care professionals are obligated to protect your privacy. They are required to keep all health care information about you confidential, unless they are required by law to share it or you give permission for information to be shared.

Q: What is HIPAA?

A: HIPAA stands for the Health Insurance Portability and Accountability Act. This law identifies the privacy rules that hospitals must follow to ensure the protection of your privacy and health information. Visit UPMC’s website to see a sample of a Notice of Privacy Practices.

Q: My doctor is recommending a procedure that is forbidden by my religious beliefs. Is there someone who can help me make my treatment decision?

A: As people sometimes misunderstand the beliefs of their religion with regards to allowed and disallowed medical treatments, you should discuss your situation with a religious advisor and your doctor to clarify exactly what is allowed and forbidden. You may also want to consult with your religious community or religious guidebooks.

Q: May I request that my treatment be adjusted to conform to my religious beliefs?

A: If you are of sound mind, you have the right to refuse treatment that goes against your religious beliefs. You may also request that your medical treatment be tailored to comply with your religious beliefs. For example, some doctors may be able to perform a procedure without the use of blood or blood product, or may offer alternatives to comply with religious beliefs that prohibit their use.

Just as you have the right to refuse treatment, doctors maintain the right to refuse to perform procedures that they believe place the patient at risk or do not comply with medical standards.

Q: Is there someone in the hospital who can help meet my spiritual needs during my stay?

A: All hospitals provide access to chaplains who minister to the spiritual needs of patients and their family members upon request. Although most hospital chaplains are trained to help people of all faiths, you may wish to inform them of the faith-based community to which you belong.

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