ethics in geriatric

8/2/2019 Ethics in Geriatric

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Ethics In Geriatricand

Chronic Illness


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Medicalization

an attitude and motivation for action thatemphasizes cure over care in health careprofessionals relationships with patients ofall ages.


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Nurse Beverly Hall (2003)

-sited three examples of medicalizationbased on her own treatment of breastcancer.

a. giving useless treatment to keep the patientunder medical care

b. demeaning and undermining efforts at self-determination and self-care

c. keeping the patients life suspended bycontinual reminders that death is just around thecorner, and that all time and energy left must be

devoted to ferreting out and killing the disease.


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Vikor Frankl (1984)

Maintained that mans search for themeaning is the primary motivation in his life.

Humans embark on the search for themeaning in order to alleviate andunderstand and to move toward to well-being.

Believed that his inner tension is a

prerequisite for mental health. Valuing the need to strive toward

equilibrium and homeostasis is wrong.


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Accepting that equilibrium is not

necessarily always the healthiest

state supports the belief thatsuffering should not be attacked as

if it is something to eliminate at all

costs.


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Rather, well-being often

involves the relief of suffering

through the acceptance of

suffering.


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George Elliot

-captured the philosophy with the wordmeliorism.

Meliorism

(negative concept)

an ethic of action oriented to toward the relief,not the acceptance, pain and suffering.

it causes doctors and nurses to work towardcuring the disease and relieving suffering at

all cost.


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Transforming acceptance.

In these instances, the goal of thenurse would be to help facilitate the

patientss acceptance of the painand suffering that cannot be

changed


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Chronic Illness

Erlen (2002) three fundamental concernsrelated to ethics and chronically ill persons.

Lack of control

Suffering

Access to services

Patients with chronic illnesses frequently feel as iftheir illness are controlling them rather thanfeeling that they are in control of their own lives.


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Suffering

the state of severe distress associated withevents that threaten the intactness of theperson. (Cassell, 1991)

Patient suffering is often related to

1. unrelieved pain

2. stigma of chronic illness

3. Disparities between the consequences ofextending life and the quality of life thatresults from the ability to extend it.


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Assessing the Capacity to Remain

at HomeDeterminations become particularly difficult whenfrail elders adamantly want to remain in or return

to their homes, and caregivers disagree with the

elders decision.

Caregiver must consider the real and perceivedmental incapacities of elders and question the

safety of their living situation.If it is believed that an elder is incapacitated, anissue of elder autonmy versus caregiverbeneficence may occur.


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Beauchamp and Childress (2001)

Weak or soft paternalisminvolves an intervention by a caregiverbased on the principles of beneficence ornonmaleficence that is enacted to protectpersons against their own substantiallynonautonomous actions.

Nonautonomous actions

are actions that are based on rationaldecision making


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Long-Term Care

Pullman (1998)

Proposed that an ethic of dignity, as opposed

to an ethic of autonomy, be used in long-term care.

Ethic of dignityfocus is on the moral character of care givers

rather than on the autonomy of therecipients of care.


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Divides dignity into:

Basic dignity - the dignity inherent in allhumans

Personal dignity -evaluative type of dignitydecided on by communities but which does nothave to be solely tied to autonomy.

Rule of justified paternalism -the degree ofpaternalistic intervention justified or required,is inversely proportional to the degree ofautonomy present.


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Elder abuse

Elder abuse includes

1. Neglect

2. Abuse, both physical and psychological

3. Financial exploitation

4. Neglect by self or caregiver


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Nurses must take an activerole in recognizing the abuse of

elders and knowing statestatues regarding the handling

of elder abuse.


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Guideline for meeting moral responsibility inreporting abuse

Report to:

Adult protective services

Long term care ombudsman (usually when an agency

or health care provider is involved)

State licensing board (when health care provider isinvolved)

Law enforcement (if required under statute)

When:

Written or verbal report within 24 hours of incident


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Age-Based Distribution of Health

CareThere has been substantial debate among

bioethicist and philosophers about the needfor a societal plan to fairly distribute healthcare resources among different generations.

It is often vulnerable populations such as thevery young (neonates) and the very old who

are the focus of discussions regardingdiscussion regarding distribution ofhealthcare resources


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Social justice in distributing health care goodsaccording to age has been described as a

type of rationing.

Rationing-a term that fits into discussionsrelated to crisis situations. (Moody, 1992)

based on scarcity of resources and is usuallythought of as a temporary situation.

-the term rationing does not accurately define amethod that is appropriate to use in makingmost decisions regarding the distribution ofhealth care resources.


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Management of Care

Travelbee (1971) described the human tohuman relationship as

mutually significant experience between anurse and the recipient of care

Each participant in the relationship perceives andresponds to the human-ness of the other; that is,the patient is perceived and responded to as aunique human-being-not as an illness, a room

number, or as a task to be performed.


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Healing (Capra,1982)

a complex interplay among the physical,psychological, social, and environmentalaspects of the human condition.

-suggests a moving toward wholeness that goesbeyond a single human being

-it is consistent with a belief in the interconnection of allbeings and the universe.

-Healing does not imply curing

-it involves a realization that all things cannot be fixed


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End of presentation

Thank you

ethics in geriatric

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