title: Novel ethical dilemmas arising in geriatric clinical practice.
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.
authors.affiliation: Grupo transfuncional en ética clínica, Centro Médico Nacional Siglo XXI, IMSS, Av. Cuauhtémoc 330, Col. Doctores, 06720, Mexico, D.F., Mexico.
authors.forename: Elisa Constanza
authors.initials: EC
authors.lastname: Calleja-Sordo
authors.forename: Adalberto
authors.initials: A
authors.lastname: de Hoyos
authors.forename: Jorge
authors.initials: J
authors.lastname: Méndez-Jiménez
authors.forename: Nelly F
authors.initials: NF
authors.lastname: Altamirano-Bustamante
authors.forename: Sergio
authors.initials: S
authors.lastname: Islas-Andrade
authors.forename: Alejandro
authors.initials: A
authors.lastname: Valderrama
authors.forename: Carmen
authors.initials: C
authors.lastname: García-Peña
authors.forename: Myriam M
authors.initials: MM
authors.lastname: Altamirano-Bustamante
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D003220:Conflict, Psychological; D026690:Ethics, Clinical; D005260:Female; D005853:Geriatrics / Q000941:ethics*; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008800:Mexico; D008875:Middle Aged; D009014:Morals; D010353:Patient Education as Topic; D011157:Population Dynamics; D024382:Professional Role; D011446:Prospective Studies; D036301:Qualitative Research; D016312:Treatment Refusal / Q000941:ethics