Ethical challenges with decision-making in elder care in Ethiopia

PhD Project by Kirubel Mussie

Ethical decision making is an important discussion in the area of elder care. This is a qualitative exploratory study based on interviews conducted between March and November 2021 with 20 older adults (aged 60 and above) and 26 health professionals in Ethiopia. The first ethical challenge is lack of informed consent as health professionals do not provide all the needed medical information and explanation to older patients due to reasons such as lack of time to explain because of high patient load, health professional lack of knowledge and ethical conduct, and thinking older patient might frustrate and/or refuse treatment if they know the truth about their health condition. The second ethical challenge is dealing with family involvement. Families and relatives of older patients often greatly influence the treatment plans of older patients and sometimes override decisions made by the older patients themselves or health professionals. Thirdly, there were ethical challenges resulting from value conflicts between health professionals and older patients. Health professionals often had dilemma choosing between benefiting the patients and respecting their autonomous decisions informed by their cultural and religious beliefs. And lastly, health professionals had ethical dilemmas with prioritising older COVID patients in the face of resource scarcity. These findings add more knowledge on the ethical challenges and considerations in elder care in low- and middle-income countries. This study also implies that health professionals dealing with tensions between health needs of older people, culture and resource scarcity need more comprehensive geriatric and ethics training.