Summary

There are two main areas where ethical issues arise for older people in health and social care. The first relates to services and the second to research. This chapter will start with general issues, such as general and demographic factors, in order to examine the ethical case for and against treating older people differently from other age groups. Are there groups, such as those with dementia, who should receive different attention? On services, ethical issues such as those relating to age discrimination and changing views on autonomy will be examined. On research, ethical procedures (including consent, confidentiality and the role of older people on ethics committees) will be considered in the context of both formal and informal arrangements.

Defining older people

There is no agreement about the definition of older people. Some take pensionable age while others use chronological age such as all people over the age of 65 or 70. Ethically it could be argued that taking a chronological age is the ‘fairest’ because of being less likely to be challenged than something more ill defined. Of interest is a new concept to emerge which is argued as ‘fairer’ and that is biological or ‘real’ age. The proponents argue that physical and mental health can be measured and that, while a person may be 60 chronologically, these individuals are some other age physically and mentally. Others argue that image defines an older person. Those who look and act ‘old’ are old. It is also argued that the definition changes with different periods of time and with varied cultures. For example, in some cultures people would define themselves as ‘old’ at a comparatively early age either because of shorter lifespans or because of the veneration associated with old age.

The importance of definitions arises because of a perceived ‘fairness’ or ‘justice’ over the provision of services and for how older people are treated. Legal and moral rights flow from the definitions. Some of the definitions of ethics, that is, ‘science of morals’ and ‘moral principles or codes’, are arguably not set in tablets of stone but subject to interpretation according to a culture and a period of time. For older people there are examples of cultural differences that can profoundly affect both services and research. At one extreme are attitudes to death and at the other views about parts of the body such as hair and nail clippings.