SCOPE: Social care opportunities to promote ethical practice
Overview
Applied ethics scholarship and research is well established in relation to health care. There is, for example a substantial literature relating to informed consent, confidentiality, truth-telling, professional/patient relationships and ethical aspects of medical treatment and clinical trials. Less attention is paid to everyday ethical issues in social care, for example, to the care of older people receiving residential, domiciliary and day care.
The distinction between ‘health’ and ‘social’ care is not always recognised as many older people receive both services. The National Health Service (NHS) is responsible for providing health and medical care relating to the treatment of illness, rehabilitation and palliative care. Local social services authorities are responsible for responding to other care and support needs – physical, emotional and practical – with the aim of promoting independence and enabling greater choice.
Engagement with social care ethics is both timely and pressing: due to the increasing care needs of an ageing population; reports of unethical practice in the social care sector; recent legal changes that impact on the funding of social care; and a workforce perceived to have low status, offered little reward for the care they deliver and having few training opportunities, particularly in relation to ethics.
Aims and objectives
The aim of the SCOPE project was to find out:
- How ‘social care’ and ‘health care’, in relation to older people, are defined in the literature and by experts; What ethical issues arise in social care for older people
- What enables or promotes ethical social care for older people
- What inhibits or challenges ethical social care for older people
- What values underpin ethical social care.
Three research methods were used:
- A literature review
- A Delphi process where an expert group reached consensus on responses to the research questions
- Interviews and focus groups with staff in residential and domiciliary care.
Two conferences were convened to bring together and gain perspectives of key stakeholders before and after the SCOPE project.
Acknowledgements
We would like to thank research participants (Delphi panel members, interviewees and focus group members) for their generous contribution to the SCOPE project and the ETHOX foundation who funded the study.
Author: Ann Gallagher with input from: Anna Cox, Kathy Curtis, Jane Leng, Mikey Dunn and Ethox Foundation Trustees.
Outputs
Findings
The literature review identified a range of ethical issues: at a micro-level relating to individuals, for example, to care-receivers’ autonomy, bodily integrity and dignity in everyday care situations: at a meso-level relating to organisational aspects of care such as staffing levels, leadership, organisational culture and material resources: and at a macro-level relating to societal and political attitudes and responses to older people and caregivers.
The literature review concludes that although there is much reference to the importance of educational and organisational strategies to promote ethical social care practices, there is no robust evidence regarding what strategies have a sustainable positive impact.
The Delphi panel reached consensus on responses to the research questions, for example: social care is ‘care that’s supports people in their “normal” day to day living, helping them to remain part of their “community”, maintaining their personal integrity as far as possible.’ Ethics is understood to mean ‘in the practical sense of the word, ethics is concerned about making value judgements in order to determine which courses of action are good or right.
More generally, ethics involves considering questions of value and goodness.’ Regarding what enables ethical social care, a consensus statement was ‘people who understand the needs of older people, and are empathetic, practical and efficient. People who understand the issues are kind.’
Recommendations
Findings from the scoping exercise suggest that the focus of social care ethics is very much on everyday issues as related to caregiving and care-receiving and on the nature and quality of relationships, particularly between caregivers and care-receivers.
The literature review, Delphi process and qualitative data also suggest that the ethics of social care needs to engage with organisational issues and societal issues, such as how the media and other bodies represent care work. There is potential to develop the political dimension of social care and to consider the ethical implications of different kinds of care relationships. We conclude that philosophical and empirical scholarship and research should focus on three levels: micro-, meso- and macro levels.
A future programme of research that engages with each of the three levels discussed in the SCOPE report could include the following areas:
- The micro- or individual level which focuses on individual’s experiences of everyday ethical issues (for example, relating to changing identities, choices, care refusal and communication decisions). This will seek to understand what inhibits and promotes individual flourishing and will give voice to care-recipients, families and caregivers.
- The meso- or organisational level which focuses on the ethical issues that arise in care organisations. This level necessitates engagement with educational and organisational responses to care challenges (for example, the conflicts of interest that may be experienced) and management and financial interests in care. The perspectives of managers, owners and investors would provide valuable perspectives to better promote the ethical climate of care organisations.
- The macro- or societal and political organisation of a care strand of a research programme will examine broader issues such as ageism, the devaluation of care by the media and the political factors that devalue both the older person in care and caregivers.
Each of these areas has both an empirical research (qualitative and quantitative) dimension and also a philosophical or theoretical aspect. Research designed to develop an evidence base for the effectiveness of ethics education form the first phase of research prioritised by the Observatory team. The researching Interventions to promote ethical education in social care (RIPE) project is funded and supported by the Ethox foundation.
Conclusions
A consensus statement from Dephi process summarises some of the challenges and opportunities that arise in relation to social care ethics and suggests a partial direction of travel for scholarship, research and education:
‘The challenge is to address the issues with non-professional staff, unregulated and often untrained. They are not subject to a professional code of conduct with the risk of removal. Often there is no support so there is a need to educate and empower the mass of workers who are often undervalued and underpaid. The word ‘ethics’ is not always understood and would be a turn-off to many, including professionals. There is an opportunity now with all the current media stories of poor care to mobilise social care staff to think more deeply about the care they give, the issues raised […] and impress on them the key role they play in caring for our ageing population.’
Our scoping activity suggests that focusing on the education and empowerment of individual workers is necessary but not sufficient to identify, develop and sustain ethical care practices. For care-receivers and the care workforce to flourish, there is also the need for organisational and political initiatives and commitment.
Research groups and centres
Our research is supported by research groups and centres.