MODULE 7 (PPT) : ETHICAL ISSUES OF Ability to voice a choice or preference.

ELDER CARE Adequate disclosure.

Understanding of information: recall
Ethics Terminology
information; manipulate information; appreciate
 Ethics
situation.
Declarations of right or wrong and what out to be
 Voluntary consent
 Bioethics
 Consistency
Application of ethics to matters of life and death.
 Ethical Dilemma 2. Informed Consent
A difficult problem seemingly in capable of a  Can make a choice.
satisfactory solution; situation involving two  Understand and appreciate the issues.
equally unsatisfactory alternatives.  Rationally manipulate information.
 Nursing Ethics  Make a stable and coherent decision.
Application of ethical principles in nursing  Age-related factors:
practice. Hearing and visual impairments.
Impaired communication: Written and verbal.
Ethical Issues of Elder Age Values and beliefs.
Decision making capacity Fluctuating or diminished decision-making
Informed consent capacity.
Refusal of treatment
3. Refusal of Treatment
Advance directive
 The right to refuse treatment even if refusal
Major ethical principles
hastens or results in their death.
Psycho-social aspects of aging
 Requisite capacity must be determined:
1. Decision – Making Capacity Can make a choice.
 Implies the ability to understand the nature and Understand and appreciate the issues.
consequences of different options, make a choice Rationally manipulate information.
among those options, and communicate that Make a stable and coherent decision.
choice.
4. Advance Directive
 Clinicians assess decision-making capacity.
 Advance directives are written statements of a
 Required to give informed consent.
person’s wishes regarding medical care.
 May fluctuate overtime from transient changes in
 It is a formal, legally endorsed document that
ability to comprehend and communicate.
provide instructions for care (living will) or names
 Competency
a proxy decision maker (durable power of
Legal determination by a judge as to mental
attorney).
disability or incapacity.
Whether a person is legally fit and qualified to Patient Self – Determination Act (PSDA) mandates:
give testimony or execute legal documents.  Provide all adult patients with written information
 The law presumes that all adults are competent concerning care decisions.
and have decision-making capacity to make health  Ask patients whether they have an Advance
care decisions. Directive.
 May fluctuate overtime.  Maintain policies re: discussions of Advance
 Cognitive impairment can lead to automatic Directive.
incapacity.  Honor Advance Directive.
 No “gold standard” for capacity determination.  Educate patients about Advance Directive.
 Conduct community education.
Verification of Decision – Making Capacity
 Do not discriminate.
 Required when a person is refusing or giving
consent for treatment and/or executing an A. Living Will
advance directive.
B. Durable Power of Attorney for Health Care for providing care and support for an
(DPOAHC) / Health Care Proxy (HCP) individual, or by a person who has
 Guardian; conservator; proxy; health care agent guardianship and administration
C. Advance Health Care Directive responsibilities for an older person.
Personal relationships with patient.
Restraints
Impaired practice.
Physical Restraints and Chemical Restraints
 Veracity
 Presumed benefit of restraint should be carefully
Honest and trust worthy in dealing with people.
weighed against the risk of complications and the
 Substituted Judgment Standard
insult it present to patients dignity.
Surrogate decision-maker.
 Physical restraint should be used only when the
 Best Interest Standard
patient is a danger for himself or others and when
Decision based on what health care providers
all other behavior management have been
and/ families decide is best for that person.
exhausted.
 It creates an obligation for the professional to Values and Codes of Ethics
attend carefully to the negative consequences of  Personal values
restraint and preventing them.  Professional Values
 Chemical restraints is by giving psychoactive  Code of Ethics
pharmacological agents. It is prescribed with Ethical Dilemmas Decision – Making Model
caution and only when for the clear benefit of the  Collect, analyze, and interpret the data.
patient.  State the dilemma.
Do Not Resuscitate Orders  Consider the choices of action.
 DNR are legal and binding but must be justified as  Analyze advantages and disadvantages of each
client request or be medically indicated. course of action.
 When DNR order is made, the supporting  Make the decision.
documentation must include client’s current  Evaluate the effectiveness of the decision.
condition, prognosis, summary of decision making 6. Psycho – Social Aspects of Aging
and who was involved.  Fear of aging- changes in roles.
Withholding and Withdrawing Treatment  Retirement and perceived non-productive sense of
 It include actions related to client’s right to refuse negative feelings.
treatment or withdraw consent for it.  Common stressors of old age:
Normal aging changes that impairs physical
5. Major Ethical Principles
functioning.
 Autonomy
Activities and appearance.
Right to self-determination, independence, and
Disabilities due to chronic illness, social and
freedom.
environment losses related to loss of income &
 Justice
decreased ability to perform precious roles and
Obligation to fair to all people.
activities lack of social interaction.
 Beneficence
Duty to act for the benefit of others; “doing Summary
good” theory.  Concept of decision-specific capacity.
 Nonmaleficence  Verification of decision-making capacity.
Do no harm.  Informed consent Refusal of treatment.
Protect patient from harm if they cannot protect  Advance directives.
themselves.  Ethics, bioethics, ethical dilemmas, nursing ethics.
Patient abandonment  Seven major ethical principles; decision-making
 The desertion of an older person by an model for ethical dilemmas
individual who has assumed responsibility
Legal Issues expectation of trust which causes harm or distress
1. Act of Negligence, Malpractice and Omission to an older person".
A. Negligence  Sexual Abuse
 It is the failure to exercise adequate care. Non-consensual contact of any kind with an
older person.
B. Malpractice  Neglect
 It is the negligence on the part of a professional The refusal or failure to fulfil a care-taking
person in providing care to another person. obligation including / excluding a conscious and
Four Conditions intentional attempt to inflict physical or
A duty to client. emotional distress on the older person.
A failure to meet that duty. Types of Abuse
An injury or negative outcome caused by not  Physical Abuse
meeting that duty. Any action that causes physical pain or injury.
Actual harm or damages suffered by the person  Psychological / Emotional Abuse
who is receiving care. The infliction of mental anguish.
C. Omission Example: Ignoring, isolating, shouting
 It occurs when something omit, that is ordered or  Financial / Material Abuse
expected as a normal part of treatment for a The illegal or improper exploitation and or use of
client. funds or resources.
 The rights of the elderly are abused when the Prevention of Abuse
family does not give them adequate care and  To increase public awareness and knowledge of
attention. the issue.
 To promote education and training of
2. Intentional Torts
professionals and paraprofessionals in
 Acts by a nurse performed with the intent to bring
identification, treatment and prevention.
about specific result.
 To further advocacy on behalf of abused and
 Assault
neglected elders.
It is an attempt or threat to injure another
 To study into the causes, consequences,
person.
prevalence, treatment and prevention of elder
 Battery
It is unwanted or unconsented physical contact. abuse and neglect.
6. Abandonment
3. Defamation
 Written or spoken communication that holds a  It occurs when dependent person or person
responsible for care leaves the older person
person up to ridicule or scorn and tends to harm
physically, emotionally, and financially
his or her reputation.
defenseless.
 Libel
Written defamation 7. Advance Directives
 Slander  Advance directives are written statements of a
Spoken defamation person’s wishes regarding medical care.
 It is a formal, legally endorsed document that
4. Invasion of Privacy
provide instructions for care (living will) or names
 Violation of a person’s right to be left alone or to
a proxy decision maker (durable power of
enjoy reasonable noninterference with his/her life.
attorney).
5. Elder Abuse and Neglect
 Elder abuse can be defined as "a single, or
repeated act, or lack of appropriate action,
occurring within any relationship where there is an