Ethical Dilemmas in Long-Term Care (Facilitator's Edition), by Janine M. Idziak. Dubuque, Iowa: Simon & Kolz Publishing, 2000. 261 pp. $182.50.

Only within the past decade or so have medical ethicists, healthcare policy analysts, and politicians devoted significant time and energy to the myriad issues and problems facing the elderly. Careful consideration has revealed multiple concerns over the treatment of the elderly by families, healthcare providers, government agencies, and facility administrators and staff. One particularly troublesome area of concern involves nursing home placement and care. Dramatic stories sometimes rise to the level of national attention and scrutiny. We hear and read accounts of elder abuse by nursing home staff, indifference by nursing home administrators, disagreements over whether to initiate or withdraw a particular life-sustaining treatment, pain management protocols, physician-assisted suicide, and the issuing and honoring of DNR orders. But then these stories, as well as the ethical and policy debates they engender, are soon forgotten by the general public. Stories often not heard at all involve the everyday, mundane problems and dilemmas faced by nursing home residents. These problems include roommate selection, waiting lists, privacy surrounding grooming and sexual relations, scheduling of meals and sleeping, confidentiality of medical conditions, freedom to walk around the facility or take trips outside the facility, and use of mechanical and chemical restraints. In one sense, these issues are more problematic and more intractable than those represented in dramatic but fleeting news accounts. What is gradually becoming obvious to many is that the problems faced by the elderly in long-term care—whether these problems are remarkable or mundane, rare or frequent—deserve sustained, careful attention.