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Clinical ethics
Clinical prioritisations of healthcare for the aged—professional roles
  1. P Nortvedt1,
  2. R Pedersen1,
  3. K H Grøthe1,2,
  4. M Nordhaug1,
  5. M Kirkevold3,
  6. Å Slettebø1,4,
  7. B S Brinchmann5,
  8. B Andersen5
  1. 1
    Department of General Practice and Community Medicine, Section for Medical Ethics, University of Oslo, Oslo, Norway
  2. 2
    Faculty of Nursing Education, Akershus University College, Oslo, Norway
  3. 3
    Institute of Nursing and Health Sciences, University of Oslo, Oslo, Norway
  4. 4
    Department of Nursing, Oslo University College, Oslo, Norway
  5. 5
    School of Professional Studies, Bodø University College, Mørkved, Norway
  1. P Nortvedt, Department of General Practice and Community Medicine, Section for Medical Ethics, University of Oslo, PO Box 1130 Blindern, NO-0318 Oslo, Norway; p.nortvedt{at}medisin.uio.no

Abstract

Background: Although fair distribution of healthcare services for older patients is an important challenge, qualitative research exploring clinicians’ considerations in clinical prioritisation within this field is scarce.

Objectives: To explore how clinicians understand their professional role in clinical prioritisations in healthcare services for old patients.

Design: A semi-structured interview-guide was employed to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis.

Participants: 20 physicians and 25 nurses working in public hospitals and nursing homes in different parts of Norway.

Results and interpretations: The clinicians struggle with not being able to attend to the comprehensive needs of older patients, and being unfaithful to professional ideals and expectations. There is a tendency towards lowering the standards and narrowing the role of the clinician. This is done in order to secure the vital needs of the patient, but is at the expense of good practice and holistic role modelling. Increased specialisation, advances and increase in medical interventions, economical incentives, organisational structures, and biomedical paradigms, may all contribute to a narrowing of the clinicians’ role.

Conclusion: Distributing healthcare services in a fair way is generally not described as integral to the clinicians’ role in clinical prioritisations. If considerations of justice are not included in clinicians’ role, it is likely that others will shape major parts of their roles and responsibilities in clinical prioritisations. Fair distribution of healthcare services for older patients is possible only if clinicians accept responsibility in these questions.

  • health priorities
  • clinical ethics
  • professional roles
  • moral values
  • geriatrics
  • health services for the aged

https://doi.org/10.1136/jme.2007.020693

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    Footnotes

    • Funding: This research is funded by the Norwegian Directorate for Health and Social Affairs.

    • Competing interests: None.

    • Ethics approval: The informants were all health personnel, and a request to the Regional Ethical Committee was therefore not necessary, since the study did not include patients and was not within the mandate of the Norwegian Regional Ethics Committees. The study was approved by the Norwegian Social Science Data Services.

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