Ethics is a scientific and philosophical discipline, whose object of study is morality, and which also guides a person toward doing good and avoiding evil. Since the time of the Greek philosopher Aristotle, who wrote the first European ethics textbook, ethics has been understood as practical philosophy. Every day, we make decisions and deal with various events, that is, we make moral choices, and we come into contact with ethics. Often we also decide between two or more positions. But even silence or a passive attitude are actions of a person that appear in their individual thinking and behavior.

The goal of ethics is the proper ordering of human actions, that is, arranging them into a methodical order in line with the demands and needs of sound, natural reason, as stated by Roháč, J. and Dancák, P. (2009, p. 61).
We describe and will subsequently examine the common ethical elements in healthcare, nursing, and social work among selected groups of people.

In this contribution we describe selected groups of citizens who are placed in institutional, social, and healthcare facilities. We also describe institutional care in domiciliary care facilities, where adult individuals who depend on another person’s help may be placed, according to Act No. 448/2008 Z.z. on social services.

We selected adult individuals who were placed in social institutions and are in a long-term adverse health or social condition. They had health or other disabilities and were hospitalized in hospital facilities, specifically in LDCH and hospices, or their overall dependence on another person’s help was also addressed through their institutional stay in a home for social services (DSS), according to the above-mentioned Law on Social Services.

Adults and seniors can also receive the needed social service in specialized facilities, where necessary round-the-clock care is ensured.
Seniors who depend on another person’s help and have reached retirement age and are placed in senior facilities are another selected group addressed in this paper.

Old age is the final stage of the aging process. Contemporary times allow life to be prolonged through modern techniques and new pharmaceuticals, but people lose the will to live. Maskalíková, T. (in: 2009, p. 26) states that an older person may feel isolated, excluded to the edge of society. Old age also has its dangers. It brings a loss of strength, fatigue, reduced sharpness of the senses and memory, and the onset of pessimism. The author further states that “older people are bearers of values that are disappearing. They are owners of wisdom we need” (in: Maskalíková, T., 2009, p. 26).

Insufficiency and dependence on another person for daily activities require continuous bio-psycho-socio-spiritual care for adults and seniors who cannot, do not know how to, or cannot carry out these activities independently, even with family help, as this article’s author states.

To enable quality aging, it is necessary to ensure good health, preserve self-sufficiency and independence of the older person, create a positive family environment, and maintain a functioning health and social system, as stated by Hudáková, A. - Obročníková, A. (2008, p. 75).

In today’s context of institutional care for seniors, the presence of abuse, neglect, and exploitation of seniors is also described. The author of this study included this topic among important ethical problems that must be identified, investigated, and, where shortcomings are found in institutional care, appropriately addressed. The author wishes to raise theoretical awareness of this topic because it has been categorized as a moral issue linked to this paper’s theme and requires more detailed attention and study.

Bužgová, R. - Ivanová, R. (2008, p. 10) describe that inappropriate treatment of seniors occurs in institutional care. They argue that it is necessary to conduct further research, but with respect and preservation of the dignity and esteem of the person being studied, since seniors are a vulnerable population.

Ethics in healthcare and nursing with selected groups of persons is addressed in the following chapter. The basic principles of medical ethics, as described by Šoltés, L. and Pullmann, R. (2008), are beneficence, non-maleficence, autonomy, and justice. These authors further mention the ethical requirements of the medical profession—physical and mental health; professional and personal competence; professional virtues of medicine: love for one’s neighbor, responsibility, selflessness, honesty, social sensitivity, and others.

Historically, medical ethics aligns with the Hippocratic Oath.
The specificity of nursing lies in the fact that it relates to every person, from birth to death, as described by Farkašová, D. (2001).

We also present selected topics in healthcare and nursing that relate to our chosen theme—the ethical dimension of health, illness, and pain; and the ethical dimension in geriatrics. We also mention the ethical aspect of psychiatric care in seniors due to specific psychiatric diagnoses in older adults described in the professional literature.

We separately address and describe ethical aspects in terminal, palliative, and hospice care. The ethical aspects of euthanasia and eschatology belong to the moral questions connected to overall care of a dying person, but also to helping that person’s family or closest environment where the dying person lives or is placed.

We consider it necessary to describe ethics in social work with selected groups of persons, as well as the ethics of the social worker, because social support is part of comprehensive care for a client in a social facility, just as it is for a patient in a healthcare bed.

A social worker, among other rules, respects the Code of Ethics of Social Workers, which we present as described by Roháč, J. and Dancák, P. (2009, p. 103).
The multidimensionality of social work is described by many authors in the field.
Čechová, J. (2001, in: Balogová, 2006) states that there are as many definitions of social work as there are theorists.
We rely on the 2010 definition of social work by Mátel, A. et al., who state that “the social work profession advocates social change, solving problems in human relationships, and empowering and liberating people to improve their well-being. Using theories of human behavior and social systems, social work intervenes in areas where people interact with their environment. Human rights and social justice principles are fundamental to social work” (Mátel. A. et al., 2010, p. 64).

Social work in healthcare is a necessary and helping component of the total care of a patient hospitalized in a medical setting.
We conclude this article by addressing the common ethical elements in healthcare and social work among the selected groups. Healthcare, nursing, and social work are fields that are interlinked and dependent on their cooperation. We will present theoretically some common ethical elements in the mentioned professions that connect them and are also implemented in practice. We present these common attributes:

  • protection of human life,
  • helping people in an unfavorable health or social situation,
  • compliance with legality,
  • adherence to ethical rules, principles, and standards,
  • humanity,
  • cooperation,
  • proactivity,
  • assertive-empathic approach,
  • social communication,
  • collaboration with other institutions and professions,
  • training of workers in the field.

We specifically focus on social communication in healthcare and social work as a crucial aspect of comprehensive care for a client or patient placed in a healthcare or social facility.
A healthcare worker can never harm a patient, as follows from medical ethical principles. When using communication techniques with patients, a doctor must not underestimate the patient. Physicians may appropriately use selective openness and gradually disclose truthful information to the patient and their relatives, as more closely described by Šoltés, L. - Pullmann, R. et al. (2008, p. 218). Medical ethics rules are followed by physicians and other healthcare professionals.

Social communication in healthcare depends on the quality of communication between doctor and patient.
Šoltés, L., Pullmann, R. et al. (2008) further describe that the subject of dialogue is not the suffering soul or the sick body, but always the sick person. A human being is simultaneously body and spirit, therefore all human actions have both bodily and spiritual character. Jendrejovský, J. (in: Šoltés, L.-Pullmann, R. et al., 2008, p. 188) states that the link between the bodily and mental spheres of the person is the spiritual dimension of every human being. Thus, the integration of body, spirituality, and psyche is the integration that forms the integrity of the human individual. Without this unity one cannot speak of healing a person as a whole.
Social communication in nursing is “the exchange of information between a nurse and a patient, between a nurse and a nurse, a nurse and a physician, or another healthcare professional.” Sidorová, E. and Jakubíková, M. (2003) describe that quality communication in nursing is conditioned by empathy, an individual approach to the patient, respect for the patient, and a positive relationship with the patient.

Communication in social work is further described by Čechová, E. and Havrilová et al. (In: Tokárová, A. et al., 2002, p. 432). They claim that in clear, precise communication it is important to:

  • know how to actively listen;
  • know how to work with questions in guiding a conversation,
  • appreciate first contact with the client,
  • appreciate the closing of a conversation,
  • value the significance and influence of the environment,
  • know the conditions under which communication failure occurs.

As Roháč, J. and Dancák, P. (2009, p. 63-70) state, moral words are easily understood and we can use them without difficulty. In everyday communication we apply a pre-understanding of moral reality, which we also assume in other people. As part of this pre-understanding of moral reality, they describe concepts such as:

  • moral evaluation,
  • conscience,
  • voluntariness,
  • responsibility,
  • social conscience,
  • and self-worth.

Ethics of spiritual care in social and healthcare facilities is an inseparable part of overall care for a sick patient or client who needs appropriate treatment or social care and the help of a person involved in their healing or stabilization of their overall health and social condition.
Spiritual care should be an important domain of effort for the entire nursing team, as stated by Miženková, Ľ. - Kilíková, M. - Kvašňáková, D. (2009, p. 26). Some life events, especially extreme situations such as serious illness, injury, and emotional stress, can relate to or challenge one’s spirituality.
Such situations can disrupt the balance of a person’s spiritual dimension to the extent that spiritual distress arises (loss of meaning in life, desire to live). The authors further state that contemporary nursing globally acknowledges that spiritual needs are as important as biological, psychological, or social needs. Therefore, deeper understanding of this dimension by nurses leads to improved quality of nursing care (Miženková, Ľ. - Kilíková, M. - Kvašňáková, D. 2009, p. 27).

As a common element in healthcare and social work among selected groups, we also included and selected some laws and patient charters because they are directly related to ethics in healthcare and to ethics in social work, as well as to the selected topic in this paper. We present:

  • Patient Rights Charter in the Slovak Republic,
  • European Patients’ Charter,
  • Convention on the Rights of Persons with Disabilities,
  • Anti-discrimination Act,
  • and the International Classification of Functioning, Disability and Health.

Conclusion

Every human decision has moral significance. It depends on each individual how, in everyday activity as well as in work, their personality, conscience, and morality are expressed. There are many criteria that unite but also divide opinions, ethical principles, or norms in carrying out individual activities in different professions. Modern times help the person on the one hand, but at the same time can also harm a person, family, group, or society.

Intersections of social work as a science with other sciences (and vice versa) are expressed through the terms multidisciplinarity and transdisciplinarity, as stated by Žilová and Tokárová (in: Tokárová, A., 2002, p. 53).

Healthcare, nursing, and social work are separate professions, but they have common elements that mutually influence and connect them.
To preserve the dignified living of every individual, sick, disabled, abandoned, poor, or elderly person, it is also necessary to respect their individual needs. At the same time, it is necessary to know and apply the professional ethics of the above-mentioned occupations in practice and to ensure the overall bio-psycho-social and spiritual component of care for every individual, regardless of age, gender, health and social status, or any other differentiation of the client or patient.
Ethics in healthcare, nursing, and social work has common elements that connect these professions, which also leads to achieving the overall bio-psycho-social-spiritual state of unity of each personality.
Mátel, A. et al. (2010, p. 14) state that in every profession, a person can encounter a situation in which at least two behavioral alternatives are possible. A worker may face an ethical dilemma when they must choose one of several solutions, none of which is entirely good. Moral problems arise when deciding between good and evil, right and wrong.

Healthcare workers, nurses, and social workers encounter and solve ethical dilemmas and moral problems daily: a physician when treating a patient, a nurse when caring for a patient, and likewise a social worker in a social services institution, where the provision of social care is ensured.
A social worker in the field of “providing social services to the client must respect that the basic rights of the human person have fundamental and supreme status,” as described by Roháč, J. and Dancák, P. (2009, p. 109).
Their correct decisions in solving clients’ or patients’ problems depend on multiple factors.

“Knowledge of ethical principles and norms shaped in the ethical code alone is not a guarantee that the respective professional will act morally, but it can certainly bring them to think about these matters, identify with them, internalize them, and as a consequence then act in accordance with them, as well as with their conscience” (Mátel, A. et al., 2010, p. 18).
In personal life and in daily work with our clients or patients, let us remember the still vivid words of Mother Teresa, who once said:
“True love hurts. It always has to hurt.
It must be painful to love someone, never to abandon them.” Author: PhDr. Jana Kollárčiková
M.V. Center for Social and Home Care, n.o.

Bibliographic references

[1] BALOGOVÁ, B. (ed.) 2006. Introduction to Social Work for Social and Charitable Service. Prešov : PbF PU, 2006. 75 s. ISBN 80-8068-504-5.
[2] FARKAŠOVÁ, D. et al. 2001. Nursing-Theory. Martin : Osveta, 2001. 134 s.
ISBN 80-8063-086-0.
[3] MÁTEL, A. et al. 2010. Ethics of Social Work. Bratislava : VŠZaSP sv. Alžbety, 2010.
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Periodical literature

[1] BUŽGOVÁ, R. – IVANOVÁ, R. 2008. Ethical aspects of researching abuse, exploitation, and
neglect of seniors in institutional care. In: Healthcare and Social Work.
ISSN 1336-9326. roč. 2008, č. 3-4, p. 8-11.
[2] HUDÁKOVÁ, A.- OBROČNÍKOVÁ, A. 2008. Quality of life in seniors.
In: Healthcare and Social Work. ISSN 1336-9326, 2009, roč. 4, č. 3-4, p. 75.
[3] MASKALIKOVÁ, T. 2009. Is aging hope? In: Healthcare and Social Work. ISSN 1336-9326, roč. 2009.4, č. 1-2, p. 26.
[4] MIŽENKOVÁ, Ľ. – KILÍKOVÁ, M. – KVAŠŇÁKOVÁ, D. 2009. Importance of
meeting spiritual needs in critically ill patients. In: Healthcare and Social Work. ISSN 1336-9326. roč. 2009, 4, č. 1-2, p. 26.

The lecture was delivered at the international scientific conference Applied Ethics in Social Work and Other Helping Professions, which took place on 20–21 October 2010 in Piešťany and was published in the proceedings of this conference:
MÁTEL, A. – SCHAVEL, M. – MÜHLPACHR, P. – ROMAN, T. 2010. Applied Ethics in Social Work and Other Helping Professions. Proceedings of the International Scientific Conference. Bratislava : VŠZaSP sv. Alžbety. 413 p. ISBN 978-80-89271-89-4.