60 Seconds with... Linda O'Brien, RN, Founder, ElderCare Ethics Associates

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Q: What have you learned from your one-of-a-kind statewide ethics program (the New Jersey SEED project) for long-term care providers? A: We say 95% of ethical problems are communications problems — people not having their views heard and respected. In the pluralistic society that we have, it's our best hope. I'm such a believer in ethics committees. They're a wonderful, safe place to get everybody's views and opinions.

Q: What type of problems are we talking about?

A: There are end-of-life issues, tube feeding, confidentiality issues, lifestyle issues, sexuality in nursing homes and alcohol. And advance directives -- both the capacity to sign them as well as implementing them, and there's the assessment of healthcare decision-making capacity. To exclude someone from the decision-making process has profound ethical implications. Maybe I can't balance my checkbook, but I may be able to make a decision. I want to go to the hospital if I have pneumonia.

Q: What issue is most likely to give a provider a problem?

A: The issues that surface the most, and are most painful for caregivers and families, are the issues around tube feedings. Q: What's been the most surprising thing about the NJ SEED project?

A: I never expected the enormous interest in this topic from long-term care facilities. It's hot, hot, hot. We had 250 long-term care facilities and 700-plus healthcare professionals in New Jersey take part. The Robert Wood Johnson foundation was extremely surprised.

To learn more about the NJ SEED project or handling ethical issues in long-term care, visit www.eldercareethicsassociates.com