Introduction

Open any book on medical ethics and look at the contents page. Look at the front page of any national newspaper. In nearly all cases the focus will be on dramatic cases, crises situations or situations in which clinicians and families are faced with what are often called ‘ethical dilemmas’. Yet the day-to-day practice of medicine and healthcare more generally is not like this. One danger of this concentration on crises is that it creates the impression that medicine and healthcare is otherwise ethically unproblematic. Nurses, doctors and other healthcare professionals know that this is not the case. Many of the most difficult and, indeed the most interesting, ethical aspects of healthcare are those that arise in daily and long-term care. In this chapter we investigate ethical issues relating to long-term care, such as truth-telling and deception, confidentiality, the ethics of mealtimes and feeding, of mobility, the ethical difficulties raised by work with patients suffering from dementia, and dealing with intimate relationships between patients.

Truth-telling