ANGELA G. ROTHROCK, PHDASSISTANT PROFESSOR

DIVISION OF GERONTOLOGY, GERIATRICS, AND PALLIATIVE CARE

NOVEMBER 6 , 2015

Ethics and Aging

Plan for the Day

Who are we?

What is ethics? Theories and approaches Being an ethical professional Working ethically with patients/clients

Who are we?

Who are the members of this group?

How are we valued?

What determines our worth?

Are our decisions ethical? Moral?

What is Ethics?

Wikipedia -- Ethics (also known as moral philosophy) is a branch of philosophy that addresses questions about morality—that is, concepts such as good vs. bad, noble vs. ignoble, right vs. wrong, and matters of justice, love, peace, and virtue.

A studying and reflecting on morality, often in a systematic way……so then, what is morality?

What is Morality?

Often first think about what we were told “to do” or “not to do” as a child What are some “morals” we learned as children? What have been 3 important influences on your

understanding of right and wrong

Concerned with relationships between people and how, ultimately, they can best live in peace and harmony

Goal is to protect a high quality of life For who? Individuals, groups, both?

So What is Morality?

It is made up of a lot of values and duties, and character traits based on beliefs that people take for granted most of the time Values –objects or things a person holds dear Duties – actions in response to claims on you that are

either self-imposed or imposed by others. Virtue – traits and dispositions or attitudes

All contribute to moral developmentSo who do you admire for being a good moral

person? Why? What are the traits that make them so?

Three Subgroups of Morality

Personal Morality The virtues, values, and duties that YOU have adopted as relevant.

May be customs, laws, rules, beliefs What are some examples? How will this impact your practice?

Societal Morality Like above, but generated by culture, ethnic groups, or geography. Almost always consider deeper religious and philosophic beliefs

about humans

Group Morality Often subscribed to by virtue of being a member of a religious

group, club, an organization, profession, or other affiliation Evident in policies, customs, and practices Hippocratic Oath – one example of a mandatory code of ethics

Ethics

Issues vs. Problems An ethical “issue” is any situation you believe may

have important moral challenges embedded in it that need to be identified

An ethical “problem” is a situation that you have reason to believe has serious negative implications regarding moral values and duties – and that will pose extremely difficult choices for individuals who want to help support high moral standards.

“That’s the moral and ethical thing to do”

What about your own conscience?

Questions

1 – imagine a situation that may arise in your professional career that would pose a challenge to your personal morality. What is it about the situation that creates the challenge.

2 – using the code of ethics from your own profession, what are 3 or 4 basic moral guidelines that you will be expected to follow?

The Caring Response

Fundamentals include: Elements of human nurturance – often like how you

would treat your family or friends Responsibilities entail clinical, ethical, and legal

dimensions The patient as a primary focus of loyalty Limits guided by the patient’s vulnerability because of

the health-related concern Recognition of it as a professional responsibility

involving duty The condition that it be individualized

Components of Ethical Problems

A – the moral agent A person who acts for him/her self, or in the place of

another by the authority of that person, and does so by conforming to a standard of right [or wrong] behavior

C – the course of action Includes the agent’s analysis, judgment process about

the resolution to the moral challenge, and decision

O – the desired outcome The intended and hoped for result(s) of having taken a

particular course of action

Reflection

Describe an ethical dilemma that you or someone you know has faced.

What did you have to take into consideration as you moved toward a decision about which of the two or more courses of action available to you should be taken?

What were the results?

Ethical Principles

Nonmaleficence and Beneficence Professionals ethics limits include “do no harm”,

“prevent harm”, and “remove harm when it is being inflicted”. Does NOT include “bring about positive good”

Autonomy the capacity to act on your own decisions freely and

independently The model of medical decision making for the past 30+

years Implications include informed consent, disclosure of

diagnoses, involvement of patients in end-of-life decisions, and advanced directives

Ethical Principles

Fidelity Being faithful to the patient – meeting the patient’s

reasonable expectations

Veracity Binds you to honesty. You will tell the truth.

Justice An arbiter. Called upon when there are problems

regarding what is rightfully due a person, institution, or society. Fair equitable, and appropriate distribution in society

Six-Step Process for Ethical Decision Making

Ethical decision require your thoughtful reflection and logical judgment – even though the situation usually presents itself via partial facts and strong reactions

The 6 Steps allow you to take the situation apart and look at it in an organized way, while still respecting the strong emotions attached.

Six-Step Process for Ethical Decision Making

Step 1: Get the Story Straight Gather relevant information

Step 2: Identify the Type of Ethical Problem

Step 3: Use Ethics Theories or Approaches for Analysis

Step 4: Explore the Practical Alternatives

Step 5: Complete the Action

Step 6: Evaluate the Process and Outcome

Reflection

1 - The first step to ethical decision making is to gather as much information as possible. What types of guidelines would you use to decide that you have as much info as you need or can obtain?

2 – a necessary step is to act on your own conclusions about what ought to be done. Under what conditions, if any, would you decide NOT to act according to your own best moral insights and judgments? That is, what, if any, are limits to your willingness to act ethically?

Being an Ethical Professional

HIPAA Health Insurance Portability and Accountability Act

http://www.youtube.com/watch?v=6wRDorQ73Ng&feature=related

Informed consent http://www.youtube.com/watch?v=h16Ujzw9VtA

Special issues for older adults

Ethics committees

Working Ethically with Patients and Clients

Special situations to consider: Medical/Advance directives

Assessing patient wishes when can’t speak for self (Cruzan, 1990) – a constitutional basis for competent patients to direct their future medical treatment through the execution of advance directives

PSDA 1990 – Federal law requires states to educate patients entering institutions regarding advance directives

Types: Living wills, durable power of attorney for healthcare, DNR. Verbal statements to primary care physician or family is also acceptable, but tenuous (sample online)

Working Ethically with Patients and Clients

Special situations to consider: Problems with Medical/Advance directives

Vague terminology such as “heroic” or “extraordinary”

Difficult to anticipate the future

Change of mind

Portability

Is this the right thing to require ethically?

Are they even used? If so, do they improve care or save money?

Working Ethically with Patients and Clients

Special situations to consider: Driving – when/if to take away the keys? http://www.cbsnews.com/video/watch/?id=5205371n

Deception – The Notebook clip http://www.youtube.com/watch?v=UZX_OxiSdSg

To old to vote? Is age even an issue to consider? Grandparent’s raising grandchildren Elder abuse http://www.youtube.com/watch?v=5cauXgZhROM&feature=PlayList&p=033753054361E5CD&playnext_from=PL&index=0&playnex

t=1 http://www.youtube.com/watch?v=OP0sZB9jRlA&feature=related

Fraud http://www.cbsnews.com/video/watch/?id=3249017n http://abcnews.go.com/Business/video/elderly-scams-11121318

Rationing of resources http://www.youtube.com/watch?v=RiTp1w48P3E