EVA projekt

Project: Ethically good care for older persons with acute health problems (ECA)

The overall aim of the ECA project is to prevent unjust treatment of older patients who have been afflicted by acute disease, injury or illness. More specifically, the project deals with the promotion of ethically good care. In order to meet the objective, an intervention is carried out within Region Kronoberg’s ambulance services with the aim to strengthen the ethical competence of the ambulance personnel.

Project information

Ethically good care for older persons with acute health problems (ECA) – Intervention to counteract unjust treatment
Project manager
Anders Bremer, Linnaeus University
Assisting project manager
Mats Holmberg, Linnaeus University
Other project members
Anna Bennesved, Stefan Engdahl, Karl Ljungström, and Joar Björk, Region Kronoberg, Anders Svensson, Carina Elmqvist, Catharina Frank, Sofia Almerud Österberg, and Bengt Fridlund, Linnaeus University, Anders Rantala, Lund University, Henrik Andersson, University of Borås, Lars Sandman, Linköping University, Mia Svantesson, Örebro Unversity.
Participating organisations
The Ambulance Services in Region Kronoberg, Linnaeus University
The Kamprad Family Foundation (area of “Improved quality of life for elderly”, call for proposals 2018)
1 January 2019–30 June 2023
Caring sciences (Department of Health and Caring Sciences, Faculty of Health and Life Sciences)

More about the project

There is a lack of research concerning ethical problems linked to the increasing population of older patients cared for by Swedish ambulance personnel. There are, however, studies that point to that ethical conflicts arise within the ambulance care of elderly.

Older patients that become acutely or seriously ill are vulnerable and in a position of dependence, in particular when the patient’s ability for decision-making is impaired, which combined increases the risk that the ambulance personnel unconsciously inflict mental, physical or ethical harm to the patient. Therefore, the focus of the ECA project is situations where older persons are afflicted by acute disease, injury or illness. In such situations, older patients can have a reduced ability to take part in decisions concerning their own care, which makes it difficult for the ambulance personnel to respect the patient’s autonomy. In a worst-case scenario, the older patient can be given a lower priority even though his/her needs do not support this, which can lead to unequal care. Older patients risk losing autonomy, the right to care based on needs, and care of good quality. Important questions must be answered: Are older persons with acute health problems given a just treatment? Are older persons given the same rights as younger patients? Are assessments and decisions affected by the older person’s position in society, the older person’s social or economic status or gender? Are older patients with larger needs prioritised above younger patients with less needs?

In order to promote an ethically good care of older persons with acute health problems, ambulance personnel must be given the opportunity to strengthen their ethical competence and their ability to reflect on ethical problems, and to practice their action preparedness. The overall aim of the ECA project is to study the ambulance personnel’s perceptions of right and wrong in the care of older patients with reduced ability to make decisions and how they handle ethical conflicts that arise. The project is carried out in three stages: a pre-study with the aim to investigate how ambulance personnel deals with ethical problems relating to the patient’s autonomy when the patient has reduced ability to make decisions, an education intervention with the aim to promote the personnel’s critical approach to how the patient’s autonomy can be protected, and an evaluation of the intervention.

The expected outcome of the project is improved quality of life and improved physical health and mental wellbeing among older persons, which is achieved through an increased ethical competence among the participating ambulance personnel. The project is expected to contribute to that the personnel handles the care of older persons, with reduced ability to make decisions, in a better way. That is to say, that ethically good care is provided, which also reduces the risk of stress among the personnel. Many people will benefit from the project’s results since a majority of the ambulance services’ patients belongs to an older population.

The project is part of the research carried out at Centre of Interprofessional Collaboration within Emergency Care (CICE) and part of the research field “Assessment, prioritisation, measures and treatment of patients in emergency care”.