Over the past few years, the Florida Department of Elder Affairs has developed an ethics initiative in response to the many challenging questions of aging in the late I99os. The purpose of the initiative is to provide information, create awareness, and develop ethics processes to assist aging people, their family members, and healthcare providers and other professionals in the field who struggle with ethics challenges that arise in Florida's new aging society. The initiative is focused on the local level, where the actual situations occur.
Two years ago the Florida Department of Elder Affairs realized that a number of concerns needed to be addressed. More and more, it seemed, older people were reporting to agency staff that they were afraid of losing control of their lives as they grew older and faced death and dying. Providers, too, were increasingly concerned by the issues they faced. For example, some older people told department staff that they were afraid to call gr II for fear that their wishes about dying would be ignored by medical providers. Providers reported that elders and their families would ask them to make personal and painful choices about where the older person ought to live, whether the person should continue to drive, whether they could remove their relative's belongings without consent if the items were considered dangerous. Some asked whether an adult child could demand that her reluctant father finally leave her home and move to a nursing home where more appropriate care would be available. Volunteers asked what their responsibilities and liabilities would be if they attempted to serve a self-neglecting person unwilling to accept care. The department also learned that more people were dying in nursing homes, assisted living and home environments rather than in hospitals. Confusion in Florida over the right to refuse treatment, "do not resuscitate" orders, Florida's unique privacy laws, and more prompted the department to accept responsibility to assemble information and materials and arrange processes to deal with some of the questions.
This was new territory for the department and for providers, because we in the department are primarily involved in long-term-care alternatives to nursing homes and hospitals and because we had heretofore ignored teaching and training on what we considered client "personal choice" matters. The initial step was a two-day session with a large advisory group of participants from many walks of life, including older people who had faced some very complex ethical and moral dilemmas. The advisory group explored the broad scope of questions and generated ideas for a starting place. Next, several focus groups were convened, with the discussion centered on a look at case studies. Some of the observations were as follows: People from varied backgrounds are eager to discuss difficult topics; group members can comfortably explore case examples in a somewhat impersonal manner-although the discussion becomes more personalized as the conversation develops; individual invitations to the participants are very effective in securing attendance. A large-audience, panel-presentation format for discussion of ethics issues was also successfully demonstrated. A number of observations that can be of specific help in developing ethics forums emerged. For example, no matter what the subject, the participants seem to need a basis of clear explanations of current law before they can effectively manage the harder ethics questions. …