Ethical dilemmas faced by women as caregivers of frail elders: A qualitative study

Informal, primary female caregivers of frail elders face profound ethical dilemmas in their efforts to provide daily care for loved ones. The purpose of this study is to identify caregivers' ethical dilemmas; identify the processes they describe in dealing with and resolving ethical dilemmas; and, identify recommendations for services to better deal with and resolve ethical dilemmas.;A sample of thirteen female caregivers was selected from clients served by a local home health agency. Selection criteria were developed from caregiving stress research and input from a consultant panel consisting of caregivers and agency staff. Semi-structured interviews explored ethical dilemmas in the areas of the history of the relationship before and after caregiving, personal feelings about caregiving, the effects of financial strain, the frail elder's resistance to help, social support, cognitive status of the frail elder, being female, and the caregiver's health. All responses were transcribed and coded. Through the use of focus groups, feedback from the consultant panel and interviewees was solicited for accuracy of findings.;Findings reveal that caregivers engage in distinct ethical decision-making processes to address ethical dilemmas. An analytical model was developed which summarized major findings including competing values and ethical principles that lead to ethical dilemmas, processes for dealing with these dilemmas, i.e., collaboration with others, and having or lacking informal and formal services such as paid caregivers to help deal with these ethical dilemmas. Feelings such as anger, the role of spirituality, and the use of assertive communication permeate caregivers' ethical decision-making processes.;Social workers need to conduct research on components of the proposed ethical decision-making model to explore complex interactions among variables. Policies and programs need to provide consistent formal, paid services, such as home-based medical social workers, as a means of helping to alleviate stressful caregiving ethical dilemmas.