Ethical issues in old age medical care

1. Ethical issues in old age medical care

2. The Four-Principles Approach developed in theearly 1980’s by well-known American bioethicists Tom Beauchamp and JamesChildress

3. Four principles 1)patient autonomy (respect the decision making capacity of others) 2)beneficence (provide benefits and balance benefits against risks) 3)non-maleficence (do noharm) 4) justice (fairness in the distribution of benefits and burdens in society)

4. Cultural Diversity • cultural or religious background shape views about meaning of life, death, and illness, the importance of relationships, the significance of quality of life, and how decisions should be made in the health care setting

5. Substitute Decision Making • the person who has the legal authority to make health care decisions on behalf of the incapable patient • Since the primary responsibility of the SDM is to decide in accordance with the patient’s wishes, the SDM should ideally be someone who has a close personal relationship with the patient and knows him or her very well

6. Use of Restraints many studies have shown that reducing the use of restraints does not correspond with increased incidences of falls and injuries among long-term care residents and patients.

7. Use of Restraints • In fact, numerous studies have shown that restraints can increase the risk of serious injury, as patients tend to struggle against the restraints. • restraints contribute to significant psychological and emotional harm in patients

8. Use of Restraints these studies support the now-prevalent view that restraints are rarely justified in the long-term care setting to protect the patient him or herself from harm.

9. Restraining a patient to protect others from harm can be justified • The important thing is that risk of harm to others must be realistically weighed against the harm to the patient and the restriction on the patient’s autonomy • the restriction on the person’s autonomy should be the least intrusive restriction that would be required to have the desired effect

10. Disclosure/Truth Telling • lying to or withholding information from patients was justified by beneficence based Hippocratic ethics • Modern western health care ethics, however, is more autonomy-based and it is commonly held by western physicians and ethicists that it is generally not appropriate to lie to or withhold information from a patient( cancer, Alzheimer's disease)

11. CPR • There is now a general consensus that, based on the ethical principles of beneficence and non-maleficence, physicians are not obligated to offer interventions like CPR in situations in which the intervention would be clinically ineffective (no obligation if not effective)

12. CPR The more difficult cases • CPR might be clinically effective but the likely harms might be said to significantly outweigh the benefits, • CPR is used to support a controversial goal(communicating and negotiating with the patient and/or family about CPR)

13. Nutrition & Hydration the consensus now is that feeding tubes are considered to be a medical intervention and should be assessed on the basis of benefits and harms as with any other medical intervention

14. Tube feeding remains a very complex issue • for many people tube feeding still represents the necessities of life • some families resist feeding tubes and demand that oral feeding continue when it poses a risk to the patient

15. Tube feeding health care professionals should remember that such decisions should be guided by the wishes and the best interests of the patient.

16. Participation in Research giving long-term care patients the opportunity to participate in research can be justified by the principles of beneficence; respect for patient autonomy, and justice

17. Participation in Research • the assent of incapable patients prior to and throughout the research; • rigorous capacity assessments, which should be repeated if the research requires long-term participation; • prohibiting patients who are incapable or whose capacity is uncertain

18. Conflicts of Interest • the primary interest of the physician should be the patient’s best interests. it is integral to the physician-patient relationship • A conflict of interest occurs when a physician’s judgment regarding his or her primary interest (the patient’s best interests) is unduly influenced by a secondary interest (e.g., money or prestige)

19. Conflicts of Interest • Conflicts of interest are problematic ethically because they can lead to a breakdown in the trust patients have in their physicians • One example of a conflict of interest is when a physician acts as both clinician and researcher at the same time

20. Professionalism • Medical professionalism is that it involves a promise to uphold certain values • the most important value of medical professionalism is that the interests of patients come before the interests of the physician