Michael Welker | Eva Winkler | John Witte, Jr. | Stephen Pickard (Eds.): The Impact of Health Care (Leseprobe)

Ethical Tensions in the Medical Treatment of Elderly Patients 47
bears the risk that therapeutic actions are omitted which could alleviate suffering,
or that the patient’s autonomy is unduly restricted.
For example, mobility is an important expression of autonomy, especially in
the face of increasingly limited cognitive resources. The ability to walk, especially
in anursing home, can enable independent choice about where to engage in
the community or whether to retreat into the private sphere in everyday life, and
should therefore be maintained or promoted as long as possible. This autonomy
must then also be weighed against arisk of falling or self-endangerment due to
orientation disorders. The claim on behalf of the greatest possible safety of the
patient, which is demanded by relatives but also by health-insurance companies
and home supervision, is often mistaken here, since it unduly limits the decisions
of the patient’s natural and free will.
On the other hand, alaissez-faire attitude must be contradicted, because it
overemphasizes apurely fateful course and often withdraws the assumption of
responsibility and the need for caring decision-making. Accommodation of apatient
in aprotected area for those experiencing dementia, while leaving them the
possibility of protected access to agarden, for example, ultimately allows more
autonomy and quality of life than the medicinal prevention of active participation
in everyday life through sedation and inhibition of movement.
However, dilemmas also arise when patients for many years have avoided
dealing with the impositions of physiological aging and age-associated diseases,
so that further intrapsychic development can nolonger take place. One-sidedly
formed couple relationships can also lead to excessive demands, and superhuman
expectations of care services by relatives or financial dependencies can be
the basis for maintaining astatus quo that is ultimately detrimental to quality of
life. Unrealistic hopes for medical success or stubborn adherence to aliving situation
that ultimately represents agilded cage and prevents everyday satisfaction
often require careful guidance and education of medical and nursing professionals.
Here, however, it is also necessary to look at the current possibilities of the
actors in the health-care system, who are often burdened with immense time
pressure and economic coercion from health-insurance companies and facility
operators. This situationpresents aspecial challenge to make time for clarifying
discussions and complex decision-making while including, for example, ahearing-impaired
patient or overprotective, partially dependent relatives. In the fastpaced
daily hospital routine, it is often difficult to allow sufficient time for the
process of arriving at such jointly supported decisions.
Bed shortages, the lack of adequate home structures, and the unwillingness
of patients and relatives to accept change are obstacles here. The refusal of the
social and health-care system to provide sufficient resources for necessary investments
in structuresand buildings, to providetransitional arrangements (for
example, sufficient short-term and interim care options), or to enable appropri-