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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