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Ethics support in institutional elderly care: a review of the literature
  1. Sandra van der Dam1,
  2. Bert Molewijk2,3,
  3. Guy A M Widdershoven3,
  4. Tineke A Abma3
  1. 1Department of Health, Ethics and Society, Caphri, Maastricht University, The Netherlands
  2. 2Center for Medical Ethics, University of Oslo, Oslo, Norway
  3. 3Department of Medical Humanities, EMGO+, VU University Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Dr Sandra van der Dam, Department of Health, Ethics and Society, Caphri, Maastricht University, Juliusstraat 45, Eindhoven 5621 GC, The Netherlands; sandravanderdam{at}


Clinical ethics support mechanisms in healthcare are increasing but little is known about the specific developments in elderly care. The aim of this paper is to present a systematic literature review on the characteristics of existing ethics support mechanisms in institutional elderly care. A review was performed in three electronic databases (Pubmed, CINAHL/PsycINFO, Ethxweb). Sixty papers were included in the review. The ethics support mechanisms are classified in four categories: ‘institutional bodies’ (ethics committee and consultation team); ‘frameworks’ (analytical tools to assist care professionals); ‘educational programmes and moral case deliberation’; and ‘written documents and policies’. For each category the goals, methods and ways of organising are described. Ethics support often serves several goals and can be targeted at various levels: case, professional or organisation. Over the past decades a number of changes have taken place in the development of ethics support in elderly care. Considering the goals, ethics support has become more outreaching and proactive, aiming to qualify professionals to integrate ethics in daily care processes. The approaches in clinical ethics support have become more diverse, more focused on everyday ethical issues and better adapted to the concrete learning style of the nursing staff. Ethics support has become less centrally organised and more connected to local contexts and primary process within the organisation.

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