Transcript Chapter 17: The Interdisciplinary Team

Chapter 20:
Ethical/Legal Principles
and Issues
Learning Objectives
• Define key ethical constructs as they
relate to the care of geriatric patients.
• Relate concepts of ethics to their
implications in the care of geriatric
patients.
• Recognize the influence of personal
values, attitudes, and expectations about
aging on care of older adults and their
families/extended families.
Learning Objectives (cont’d)
• Analyze the impact of fiscal, sociocultural,
and medico-legal factors on decision
making in the care of geriatric patients.
• Identify strategies for facilitating
appropriate levels of autonomy and
supporting the right to self-determination
decisions in the care of geriatric patients.
Case study: ethical or moral
dilemma
An 80 year old patient in the nurse’s care just
emphatically told her during the admission
process that he does not wish any life
prolonging procedures to be done if he should
“code”. The nurse leaves the room to begin
the appropriate referrals and paperwork for
advance directives. When she returns, the
patient is not breathing and has no pulse.
Case study questions
• What should the nurse do?
• What is the nurse bound legally to do?
• What ethical principles are in conflict in
the given situation?
• What other options does the nurse have
to uphold the patient’s autonomy?
• Are there any foreseeable problems in
this situation?
Ethical/Legal Principles and Issues
• Ethics of care in the geriatric population is
complex and challenging
• Nursing Practice requires mindfulness of a
person’s autonomy within changing capacity
Ethical/Moral Principles
Advocacy
Autonomy
Beneficence/
nonmaleficence
Confidentiality
Fidelity
Fiduciary responsibility
Justice
Quality of life
Reciprocity
Sanctity of life
Veracity
Conflict and Dilemma
• Ethical conflict occurs when a choice must
be made between 2 equal possibilities.
• 3 types of moral conflict: moral distress,
moral uncertainty, and moral dilemma.
• Moral distress
– When someone wants to do the right thing but
is limited by constraints of organization or
society.
Conflict and Dilemma (cont’d)
• Moral uncertainty
– Confusion in situations when a person is
uncertain what the moral problem is or which
moral principles or values apply to it.
• Moral dilemma
– When two or more moral principles apply that
support mutually inconsistent actions.
Moral Principles
• Incorporated into professional code of
ethics
• Advocacy:
– Loyalty and a championing of the needs and
interests of others.
– Nurses advocate for patients by supporting
them in their efforts to retain as much
autonomy as their abilities allow.
- Protecting the health and safety of clients by
communicating needs, promoting safe
environments, and helping with assertion of legal
rights.
• Autonomy:
– Person’s right to make independent decisions
– Respect for personal liberty, values, beliefs, and
choices
• Beneficence:
– To do good
– To prevent or remove harm
– More proactive than nonmaleficence
• Nonmaleficence
– Not to inflict harm or evil
• Confidentiality
– Duty not to disclose information shared in a
trusted manner or relationship
– Privacy: duty to respect limited access to a
person
– Health Insurance Portability and Accountability
Act (HIPPA)
• Fidelity
– Duty to honor commitments
– Keeping promises or being true to another
– Trust is earned, and fidelity is demonstrated in
daily work
• Fiduciary Responsibility
– Health care professionals have an ethical
obligation to good stewardship of both the
patient’s and the organization’s fund
• Justice
– Providing equal care for all patients
– Fairness of an act or situation
• Veracity
– Truthfulness
– Not misleading patients or their families
– Duty to be honest, tell the truth, not deceive
others
• Reciprocity:
Golden rule. A feature of integrity
concerned with the ability to be true to
one’s self while respecting and supporting
the values and views of another. Passive
resistance does not support reciprocity. If a
nurse cannot demonstrate reciprocity,
another should take his or her place in the
care of the patient.
Moral Principles
• Informed consent
– Elements to include in discussion
• The specific condition requiring treatment
• The purpose and distinct nature of the procedure or
treatment
• Potential complications or risks associated with
the procedure or treatment
• Reasonable alternatives with a discussion of their
relative risks and benefits
• Discussion of the option of taking no action
• The probability of success of the recommended
treatment or procedure
Patient Rights
• Patient rights direct actions on ethical
issues in the care of geriatric populations
• The Patient Self-Determination Act of
1990: patients are provided the
opportunity to express their preferences
regarding life-saving or life-sustaining care
on entering any healthcare service,
including hospitals, long term care centers,
and home care agencies.
-Terri Shiavo case
Patient Rights
• Advance directives and living wills
– Advance directive: describe actions to be
taken if the patient is no longer able to provide
informed consent
– Living will: direct preferences for end-of-life
care issues, providing an “if I am terminally ill
and not expected to recover, then ...” plan
• Durable power of attorney
– Legal document designating alternative
decision maker in the event the person is
incapacitated
Patient Rights
• Competence
– Mental clarity and appropriateness for decision
making based on a mental status exam
– Required for persons to exercise autonomy
and right to decide
• Assisted suicide (p.727)
– Violation of the Code of Ethics for Nurses
– Oregon: Death with Dignity Act (1997)
Ethics in Practice
• Medical errors
– Considerable effort has been put into
reducing mistakes and improving patient
safety.
– Average hospital patient can expect to be
subjected to at least one medication
error per day
Summary
• Nurses respect the worth, dignity, and
rights of the elderly as they provide care
that meets their patients’ comprehensive
needs across the life span continuum.
• Scope and Standards of Practice (ANA)
• Framework for ethical decision making
provides a foundation for discussion when
dilemmas arise, smoothing the way for
integrity-saving compromise.