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Ethical Issues of Elder Care

Ethical Issues of Elder Care. Objectives. Apply the concept of decision-specific capacity to older adults. Apply legal and ethical principles in the analysis of complex issues related to care of older adults: informed consent, refusal of treatment, and advance directives

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Ethical Issues of Elder Care

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  1. Ethical Issues of Elder Care

  2. Objectives • Apply the concept of decision-specific capacity to older adults. • Apply legal and ethical principles in the analysis of complex issues related to care of older adults: informed consent, refusal of treatment, and advance directives • Define ethics, bioethics, ethical dilemma, and nursing ethics.

  3. Objectives • Describe the major ethical principles that have an impact on older adults’ health care. • Discuss the difference between personal values and professional codes of ethics. • Apply a decision-making model to an ethical dilemma in nursing practice.

  4. Decision-making Capacity • Implies the ability to understand the nature and consequences of different options, make a choice among those options, and communicate that choice. • Clinicians assess decision-making capacity. • Required to give informed consent • May fluctuate over time from transient changes in ability to comprehend and communicate

  5. Decision-making Capacity • Competency.Legal determination by a judge as to mental disability or incapacity; whether a person is legally fit and qualified to give testimony or execute legal documents. • The law presumes that all adults are competent and have decision-making capacity to make health care decisions.

  6. Decision-making Capacity • Decision-specific capacity vs. global decisional capacity • May fluctuate over time • Cognitive impairment automatic incapacity • No “gold standard” for capacity determination

  7. Verification of Decision-making Capacity • Required when a person is refusing or giving consent for treatment and/or executing an advance directive • Ability to voice a choice or preference • Adequate disclosure • Understanding of information: recall information; manipulate information; appreciate situation • Voluntary consent • Consistency

  8. Informed Consent • Can make a choice • Understand and appreciate the issues • Rationally manipulate information • Make a stable and coherent decision • Age-related factors: • Hearing and visual impairments • Impaired communication: written and verbal • Values and beliefs • Fluctuating or diminished decision-making capacity

  9. Refusal of Treatment • The right to refuse treatment even if refusal hastens or results in their death. • Requisite capacity must be determined: • Can make a choice • Understand and appreciate the issues • Rationally manipulate information • Make a stable and coherent decision

  10. Advance Directive (AD) Patient Self-Determination Act (PSDA) mandates: • Provide all adult patients with written information concerning care decisions • Ask patients whether they have an AD • Maintain policies re: discussions of AD • Honor AD • Educate patients about AD • Conduct community education • Do not discriminate

  11. Advance Directives • Living Will • Durable Power of Attorney for Health Care (DPOAHC) or Health Care Proxy (HCP) • Guardian; conservator; proxy; health care agent • Advance Health Care Directive

  12. Ethics Terminology • Ethics: declarations of right or wrong and what out to be • Bioethics: application of ethics to matters of life and death • Ethical dilemma: a difficult problem seemingly incapable of a satisfactory solution; situation involving two equally unsatisfactory alternatives • Nursing ethics: application of ethical principles in nursing practice

  13. Major Ethical Principles • Autonomy • Justice • Beneficence • Nonmaleficence • Veracity • Substituted Judgment Standard • Best Interest Standard

  14. Ethical Principles • Autonomy – right to self-determination, independence, and freedom. • Justice – obligation to fair to all people • Beneficence – duty to act for the benefit of others; “doing good” theory

  15. Ethical Principles • Nonmaleficence – do no harm; protect patient from harm if they cannot protect themselves • Patient abandonment • Personal relationships with patient • Impaired practice • Veracity – honest and trustworthy in dealing with people.

  16. Ethical Principles • Substituted Judgment Standard – surrogate decision-maker • Best Interest Standard – decision based on what health care providers and/or families decide is best for that person.

  17. Values and Codes of Ethics • Personal Values • Professional Values • Code of Ethics

  18. Ethical DilemmasDecision-making Model • Collect, analyze, and interpret the data • State the dilemma • Consider the choices of action • Analyze advantages and disadvantages of each course of action • Make the decision • Evaluate the effectiveness of the decision

  19. Summary • Concept of decision-specific capacity • Verification of decision-making capacity • Informed consent • Refusal of treatment • Advance directives • Ethics, bioethics, ethical dilemmas, nursing ethics • Seven major ethical principles; decision-making model for ethical dilemmas

  20. Questions?

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