Navigating ethical challenges in aged care: The role of clinical education – opinion

Aged care in Australia, as in many parts of the world, faces significant challenges as the population ages and demand for care grows. Ethical decision-making in aged care is not an abstract ideal but a practical necessity, one that directly impacts the quality of care provided to some of society’s most valued individuals.

As a clinical educator and bioethicist, my focus is on integrating ethics into clinical education to equip all staff involved in care delivery with the tools they need to navigate the ethical dilemmas that can arise.

Locally, the Royal Commission into Aged Care Quality and Safety highlighted both the strengths and areas for improvement across the sector, bringing attention to issues such as workforce shortages, gaps in training, and care standards. Yet it is important to note that these challenges do not represent all aged care providers; many facilities are committed to high-quality care, proactively aligning their practices with Quality Standards, and fostering ethical practices through policy and education.

Aged care has a number of ethical challenges rooted in diverse aspects of care. These include the following:

• Resource constraints
  Managing resources, especially in standalone or regional facilities, poses a significant ethical challenge. Staff may face difficult decisions about allocating time and resources to meet residents’ needs while maintaining compliance with care standards. Decisions in these situations go beyond practical concerns and involve ethical considerations aligned with Aged Care Quality Standard 3, which emphasises personal and clinical care.
  
• Balancing safety and autonomy
  People working in aged care often encounter situations requiring a balance between resident autonomy and safety. For instance, residents may wish to pursue activities or dietary choices that pose risks. Supporting residents’ choices while ensuring their safety involves more than clinical skills; it requires a foundation in ethical principles to guide appropriate actions and careful documentation.
  
• End-of-life care
  In aged care, end-of-life decisions may involve complex choices about pain management, quality of life, and respecting residents’ wishes. The Covid-19 pandemic, with its associated restrictions, underscored these challenges and highlighted the importance of ethical support for staff in navigating difficult situations, as outlined by Aged Care Quality Standard 8, which emphasises governance.
  
• Cultural and religious sensitivity
  Australia’s diverse population means aged care staff often encounter residents from various cultural, religious, and linguistic backgrounds. Providing culturally competent care can create tension between residents' expectations and standard practices. Ethical training that includes cultural competence helps staff approach these situations with greater sensitivity.
  
• Dementia care
  Cognitive decline in dementia care brings unique ethical considerations, particularly around autonomy, consent, and restrictive practices. Decisions in these areas must reflect ethical standards that prioritise dignity and choice, supported by frameworks like Aged Care Quality Standard 3.

Ethical challenges are an integral part of clinical practice in aged care, yet they are often addressed separately from essential clinical skills.

While technical knowledge is indispensable, the ability to think ethically and critically is equally important. Staff need both the practical skills to perform tasks and a clear understanding of the values underpinning their actions: dignity, respect, integrity, compassion, and a commitment to resident autonomy.

For example, when a resident refuses medication, the care worker’s response should reflect a framework that balances the resident’s autonomy with health considerations. This involves respecting the resident’s decision-making rights while documenting the refusal responsibly. Such ethical awareness helps ensure that actions taken support the resident’s agency, helping avoid potential conflicts between compliance and respecting residents' choices.

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The role of clinical education in promoting ethical care

Clinical education can address ethical dilemmas directly, integrating ethics into every training aspect so that aged care workers are better prepared for the complexities they encounter daily.

• Embedding ethics into training programs
  Embedding ethics into training through case-based learning allows staff to discuss real-life scenarios that address ethical dilemmas alongside clinical decisions. This approach develops critical thinking and enables staff to apply ethical principles to practice.
  
• Continuous ethical reflection
  Clinical education should be an ongoing process that encourages reflection and growth. Group discussions, debriefings, and ethical audits allow staff to remain aware of the ethical dimensions of their work, promoting continuous ethical reflection.
  
• Incorporating Ethical Leadership
  Leaders play a vital role in promoting an ethical culture. Educators must train not only frontline staff but also leaders who model ethical behavior, setting a positive tone throughout the organisation.
  
• Interdisciplinary learning
  Ethical challenges often require an interdisciplinary approach. Training programs that involve diverse professionals foster collaboration and ensure that decisions are comprehensive and well-rounded.
  
• Cultural competency and sensitivity
  Aged care staff must navigate the ethical complexities of caring for residents from diverse backgrounds. Cultural competency training fosters an understanding of residents' values and beliefs, which is essential in a multicultural society like Australia.

In addition to clinical education, incorporating ethical considerations into policy and procedure helps formalise ethical behaviour. Policies that include decision-making frameworks provide staff with clear guidelines for challenging situations, reinforcing ethical practice within the organisation.

Addressing the gaps in ethics training

Despite the importance of ethics in aged care, there is room to expand formal ethics training in many clinical programs. Addressing this gap ensures that staff can approach ethical challenges confidently.

• Targeted ethics modules
  Adding ongoing targeted ethics modules to aged care training programs helps fill this gap. Covering key ethical concepts – such as autonomy, beneficence, and justice – these modules can be provided through e-learning, workshops, or as part of induction programs.
  
• Creating safe spaces for ethical discussion
  Establishing safe spaces, such as ethics committees, allows staff to bring forward ethical concerns without fear, promoting open dialogue and support.
  
• Incorporating resident and family voices
  Including resident and family perspectives in ethics education helps staff better appreciate the ethical aspects of care, ensuring that decisions align with those they care for.
  

In conclusion, I look forward to seeing a greater emphasis on ethics within aged care, where clinical education programs foster not only practical skills but also strong ethical awareness.

By embedding ethics more deeply into both policy and practice, we can equip aged care workers to confidently and compassionately navigate the complexities of their roles.

My hope is that a more ethically grounded approach to care will support a culture of respect, dignity, and quality for all residents and their families.