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Novel ethical dilemmas arising in geriatric clinical practice

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Abstract

The purpose of this study is to determine empirically the state of the art of the medical care, when healthcare personal is confronted with ethical dilemmas related with the care they give to the geriatric population. An observational, longitudinal, prospective and qualitative study was conducted by analyzing the correlation between healthcare personnel–patient relationship, and ethical judgments regarding dilemmas that arise in daily clinical practice with geriatric patients. Mexican healthcare personnel with current active practices were asked to write up an ethical dilemma that arose frequently or that had impacted their medical practice. From the narrative input, we were able to draw up a database with 421 dilemmas, and those corresponding to patients 60 years and older were selected (n = 54, 12.8 %). The axiological analysis of the narrative dilemmas of geriatric patients was made using dialectical empiricism. The axiological analysis values found most frequently were classified into three groups: the impact of healthcare, the roles of the physician, and refusal of therapy; the healthcare role of educator, caring for the patients’ life and the risk of imminent death where the values found more often. The persistence and universality of certain dilemmas in geriatrics calls for awareness and requires a good training in the ethical discernment of these dilemmas. This would help to improve substantially the care and the life quality of this population.

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Acknowledgements

We are indebted to all professors and participants who were involved in the on-line clinical ethics course. The authors are also indebted to the healthcare personnel who generously shared their experiences. This work was supported by the Mexican Council of Science and Technology (CONACYT) [Salud 068673] and the General Direction of Academic Personnel Affairs of UNAM (DGAPA) for the Papiit project [ID 400112].

Conflict of interest

All authors declare no competing interests.

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Authors and Affiliations

  1. Grupo transfuncional en ética clínica, Centro Médico Nacional Siglo XXI, IMSS, Av. Cuauhtémoc 330, Col. Doctores, 06720, Mexico, D.F., Mexico

    Elisa Constanza Calleja-Sordo, Adalberto de Hoyos, Jorge Méndez-Jiménez, Nelly F. Altamirano-Bustamante, Alejandro Valderrama & Myriam M. Altamirano-Bustamante

  2. Centro de Investigaciones Económicas, Administrativas y Sociales, IPN, Lauro Aguirre 120, Agricultura, Miguel Hidalgo, 11360, Mexico, D.F., Mexico

    Adalberto de Hoyos

  3. Instituto Nacional de Pediatría, Secretaría de Salud, Insurgentes Sur 3700, Insurgentes Cuicuilco, 04530, Mexico, D.F., Mexico

    Nelly F. Altamirano-Bustamante & Alejandro Valderrama

  4. Unidad de Investigación de Enfermedades Metabólicas, Centro Médico Nacional Siglo, XXI, IMSS, Av. Cuauhtémoc 330, Doctores, 06720, Mexico, D.F., Mexico

    Sergio Islas-Andrade & Myriam M. Altamirano-Bustamante

  5. Unidad de Investigación epidemiológica en servicios de salud. Área envejecimiento, Centro Médico Nacional Siglo XXI, IMSS, Av. Cuauhtémoc 330, Doctores, 06720, Mexico, D.F., Mexico

    Carmen García-Peña

Authors
  1. Elisa Constanza Calleja-Sordo
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  2. Adalberto de Hoyos
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  3. Jorge Méndez-Jiménez
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  4. Nelly F. Altamirano-Bustamante
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  5. Sergio Islas-Andrade
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  6. Alejandro Valderrama
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  7. Carmen García-Peña
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  8. Myriam M. Altamirano-Bustamante
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Correspondence to Myriam M. Altamirano-Bustamante.

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Calleja-Sordo, E.C., de Hoyos, A., Méndez-Jiménez, J. et al. Novel ethical dilemmas arising in geriatric clinical practice. Med Health Care and Philos 18, 229–236 (2015). https://doi.org/10.1007/s11019-014-9593-6

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  • DOI: https://doi.org/10.1007/s11019-014-9593-6

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