Seeing several sides of the story: Unpacking an ethical dilemma in home-based care

Abstract

Healthcare professionals in home-based care face various challenges at the system and patient levels, which can lead to ethical dilemmas. In addition, home-based care workers lack arenas to share their experiences, as they are often scattered across the care district, work alone, and do not have the immediate support of a colleague. Based on ethnographic fieldwork among professional caregivers in home-based care in Norway, we present a case of an ethical dilemma that occurred during a patient visit. Using a narrative ethics approach, we unpack the case into six “stories” and show the context of the ethical dilemma. Home-based care staff may not be aware of an ethical dilemma as it unfolds. Reflection on the case leads us to suggest that staff would benefit from some form of clinical ethics support to learn, share stories, and receive support. We also suggest that professional caregivers and patients would benefit from advance care planning as a way to clarify expectations between patients and healthcare professionals. Clinical ethics support and advance care planning are ways for staff and patients, respectively, to let their voices and stories be heard.