Everyday Ethics

In the past three years, the New York City Long-Term Ethics Network, and through these pages of the Ethics Network News, has addressed many of the cutting edge ethical dilemmas of contemporary health care. We shall continue to look at these often thorny issues in the future. The focus of this issue addresses the ethical implications of the "ordinary" and daily facts of life in a nursing home setting. The correlation with the so-called "major" issues of ethics in this environment is significant.

While every nursing home staff member is mandated to attend compulsory in-services on ethical behavioral topics such as "Residents' Rights" and "Elder Abuse" the question arises: Does the ethical training conveyed in formalized staff education resonate with daily practice in the long- term care setting? One area of concern is the effect of the dynamics of institutionalization on the life of a nursing home resident. For example, if a fictitious Mrs. Jennifer Winston, a 65 year old former teacher, a church leader and a woman who is well respected in her community is admitted to nursing home life, one may wonder how her self respect and esteem might be affected when she is addressed as "Jennie" by a nineteen year old orderly. This in and of itself may be upsetting enough to Mrs. Winston's sense of dignity. Let us further consider the effect on her if due to staff cutbacks a male orderly administers her bath. Should we be surprised if "Jennie" refuses her next scheduled bath?

Respecting the "rights of the elderly" may extend to the arena of sexual expression and orientation as well. It is these "ordinary" events that each of us faces every day on the front lines of working with the institutionalized elderly that shape the direction of ethical protocol in individual decisions of personhood regarding artificial nutrition and withholding medical treatment. Perhaps the notion of a "Living Will" should not be reserved as a euphemism for End of Life decisions but should rather reflect a daily ethical contract which begins with the resident's first day of admission to a nursing home. grounded in the Golden Rule of Ethical Behavior. The practical results of raising the consciousness of "ordinary, everyday ethics" may well redefine the character of the global ethical practices of the institutional setting as we know it. Ultimately, developing this higher standard of relationship between caregivers at all levels of care and between nursing home residents and their families, will clearly engender the kinds of active listening skills necessary for staff to accurately provide a continuous quality of environment. This is also a prime opportunity for staff to develop transferrable skills for initiating Advance Directives documentation. Furthermore, this protocol will not only assure nursing home administrators that their facilities will pass muster on State Surveys but, conceivably, it will also do justice to the moral and ethical imperatives which set a positive role model for our greater society. As nursing home residents serve as conduits to Generation X, let's not forget the generation which strives to live by the why's and our role as caregivers in respecting and supporting their value system.

The essays in this issue of the Ethics Network News attempt to bring these everyday ethics into clearer focus and force the reader to reexamine the importance of activities of daily nursing home life in that light. We invite your comments and dialogue on the sometimes extraordinary results of ordinary work with long-term care residents.

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