Reflect on the resolution of the dilemma and what you have learnt from the experience
2014: Ethical dilemmas faced by carers and people with dementia
Ethical dilemmas are not about making one-off decisions. It is therefore important to consider situations, any decisions made and subsequent changes over a period of time. The ethical dilemma and attempts to resolve it may have had an impact on the family dynamics and on individual relationships. Similarly, the resolution of the dilemma may have contributed towards a different situation which will gradually unfold and may lead to other issues which will affect people’s lives. It may be helpful to reflect on these issues and their implications and especially with hindsight to learn from the experience, bearing in mind that you did your best.
Looking at obstacles to resolving ethical dilemmas
Adopting a structured, reflective and compassionate approach to tackling ethical dilemmas, involving everyone concerned and focusing on people’s lived experiences should, hopefully, contribute towards resolving ethical dilemmas you may encounter. However, we are sometimes hampered by emotional and psychological issues from the past, as well as by habits and ways of thinking which are no longer appropriate or helpful. With the aim of maximising the potential to tackle ethical dilemmas successfully, we draw attention in this section to a few possible mental traps and highlight the need to be open to other people’s experience in order to increase our understanding of the situation and of possible options. Some of these approaches have been used in the domains of psychotherapy and counselling to help people to become aware of their thought processes and how these might be affecting their behaviour. They have not been specifically applied to ethical dilemmas but may be helpful to some people.
Being weighed down by old baggage
Often, we let ideas, influences and habits from the past affect how we approach current situations. We may have come to accept sayings, values and certain ways of doing things more or less as facts or “reality”. However, our current situation, our relationships and what is important to us and other people at this moment may have changed. It may help to reflect on what we take for granted. We may find that certain long-held values, beliefs and assumptions are not as important as we thought they were. They may turn out to be hindering our ability to tackle a current dilemma.
The need to be realistic
Sometimes, we strive for excellence or the perfect solution when “good enough” would actually be the best option (3). We cannot always do what we would like to do for our loved ones as we are constrained to some extent by social, political and economic factors as well as our own limits. For example, somebody might want to resign from their job in order to care for their parent or partner but doing so might jeopardize their future financial security or the well-being of other members of the family. Another person might want to care for their loved one at home but their own health problems might make this impossible. We are therefore not all-powerful (7). It is sometimes necessary to make compromises, settle for less than “the perfect solution” and try to come to terms with the fact that the end result is not ideal or what we had hoped for.
Expertise and knowledge may at times block openness to finding the best approach. Someone who approaches the situation with no specific expertise or knowledge may have greater openness, fewer preconceptions and a willingness to consider all possibilities. At the same time, input from people with different kinds of expertise can be helpful. It may therefore be beneficial to bring together relevant people from different backgrounds to discuss the situation and issues at stake and give equal value to the views of people who have no apparent expertise in the domain.
The impulse to take action and solve problems
In recent years, “problem solving approaches” have been criticised, especially in the context of complex, unclear (known as messy) situations (3). In such situations, a problem-structuring approach may be beneficial. This involves taking the time to explore and understand the problem before looking for a solution. It is important to ensure that the problematic situation, which is posing an ethical dilemma, has been fully explored before attempts are made to resolve it.
Either/or thinking (see also page 4) often involves an over-simplification of situations. Life is fairly complex and there are often far more options, including opportunities and outcomes, than we imagine. Complexity may contribute towards ethical dilemmas, but it is necessary to reflect on that complexity in order to understand fully the issues at stake. This may sometimes hold the key to a positive outcome.
Sometimes, we presume that we know what people think or how they will react (e.g. “If I asked her …., she would obviously think….” or “if I did that, he would….”). Even if we know someone very well, mind reading deprives the other person of the opportunity to decide for themselves and even to surprise us by their attitudes or actions.
Where there has been an unsatisfactory situation or decision (e.g. you are suddenly asked, without preparation, to make a decision about whether or not your loved one goes into a care home) that has led to a dilemma, it can be helpful to ask for a meeting, give feedback, take assertive action or even lodge a complaint. This may help to provoke an apology or bring about positive changes for the future. However, it is not usually helpful to your own well-being to dwell on blaming others for the current dilemma, however justified you may feel in doing so. Blaming serves little purpose in improving the situation and may result in you feeling increasingly bitter, as well as jeopardising relationships. It is more constructive to try and reconcile yourself to the idea that you cannot change the past but can try to influence the present and future circumstances (3).
Last Updated: Monday 08 February 2016