Ethics advisory to encompass social and health sectors in unisonEstablished in 1998, Finland's National Advisory Board on Health Care Ethics has until recently only dealt with ethical matters concerning health care and the status of patients. This has now changed, and the advisory, known by its Finnish acronym ETENE, is being expanded to cover social care.
"Many of the ethical questions concerning the social and health sectors are similar in nature. It's appropriate that they are dealt with by a common advisory," explains ETENE's General Secretary, Aira Pihlainen. "The difference is that in social care the perspective is generally broader than in health care."
Legislative changes are being made to broaden the scope of ETENE to encompass matters concerning social care clients and working methods. These changes are being done by amendments to existing laws on the status and rights of clients within social care and on the status and rights of patients in health care.
Pihlainen points out that the values enshrined by the two laws are highly congruent. "Both laws emphasize clients' and patients' basic rights, dignity, equality, interests, good treatment, care and service."
ETENE's tasks and activities are stipulated by government decree. The newly expanded body will be known as the National Social and Health Ethical Advisory Board.
In covering both health and social care, the advisory will deal with the different emphases of the ethical considerations of the two sectors. "In health care ethics the perspective is that of the interests and good treatment afforded to patients. Ethical questions in social care concern, in addition to the situation of individuals, the situation facing families, housing, and managing with life and work."
For instance, in matters of child protection it is not enough solely to consider the interests of the child, but to look at the welfare of the whole family. Issues concerning income support crucially deal with responsibilities concerning family subsistence. In the health sector the treatment and care of patients also involves their families and near ones, but if patients so wish, their case is kept in confidence, even from their families.
"At present, ETENE is dealing with the ethics concerning the treatment and the protection of and limitations to the rights of self-determination of mental health patients, people with disabilities and dementia. Both are social and health care issues," Pihlainen explains.
Until now, ethical matters concerning social care have on the whole been dealt with in the joint handling of social and health care matters, such as care for older people, organizing care in the home or in institutions, or care medicalization. Many principle ethical questions equally concern social care clients as health care patients.
The scope of ETENE's work will expand to include wholly new issues. These include ethical matters concerning income support, subsistence support, client fees, social benefits and social credits.
"The social care issues that will be dealt with depend on the issues about which the advisory board is contacted and asked to make pronouncements, or what the members of the advisory board raise. One important matter concerns being involved in the reform of social care legislation," says Pihlainen.
Ethical matters concerning health care come to ETENE's attention from a variety of sources. Departments of the MSAH have requested advisory positions as the basis for legislation, and health care personnel have requested recommendations on practical working methods.
"I think that it is good that we are asked for standpoints before laws are prepared," says Pihlainen. "Once a law is ready, it is difficult to intervene in it from an ethical angle."