Ethics of Aging Flashcards
list the four principles that govern clinical research of biomedical ethics
Respect for Autonomy
Nonmaleficence
Beneficence
Justice
etymology of the word autonomy
autos = self and nomos = rule, governance, law
definition of autonomy
The right of persons to make authentic choices about what they shall do, and what shall be done to them and, as far as is possible, what should happen to them.
what is the princinple of beneficence
refers to a statement of moral obligation to act for the benefit of others.
requires that an agent take positive steps to help others, not merely refrain from harmful acts.
what is paternalism
The intentional overriding of a patient’s preferences by:
Manipulation of information
Nondisclosure of information
Deception
Lying
Coercion
and justifying this action by:
Reference to the patient’s best interests;
Preventing harm to the patient;
Mitigating harm to the patient.
what is the principle of nonmaleficence
DO NO HARM
DUE CARE
Taking sufficient and appropriate care to avoid causing harm, as the circumstances demand of a reasonable and prudent person.
What is the principle of justice
Obligates to provide fair, equitable and appropriate treatment for patients
in what cases do healthcare use rationing when a patients behaviours causes their own ill health
Smokers
Obese People
Over consumption of alcohol
Risky sexual behaviour
Risky activities in life
list tools of ethical reasoning
Four Principles method
Four Questions method
BMA Method
how is the four principles method applied
4 principles of biomedical ethics
Respect for autonomy
Beneficence
Nonmaleficence
Justice
balance - find reasons about which moral norms should prevail
specification - adding content to your analysis of a case
use judgement and make decision
what must be considered when a person lacks capacity to make a decision
greatest extent possible give effect to the past and present will and preference of person
be done in good faith and benefit of person
minimise restrictions of persons rights and freedom of action
have due regard the rights of person to dignity, bodily integrity, privacy, autonomy and control over his or financial affairs and property
be proportionate to significance and urgency of situation
what is informed consent
Every human being of adult years and sound mind has a right to determine what shall be done with his body
what is your role as a healthcare worker when it comes to cnsent
patients decision is informed
their consent is NOT simply a formality or a signature on a page
5 Elements of informed consent
disclosure of information
comprehension
voluntariness
competence
agreement
how must the patient be informed about the condition and treatment
the nature of the condition;
the type of investigation;
the complexity of the treatment;
the risks associated with the treatment or procedure (and the risks of non- treatment); and
the patient’s own wishes.
what are the principles of assisted decision making -assisted decision making Act 2015
statutory presumption of capacity
person will not be found to lack capacity to make decisions unless ALL practicable steps have been taken w/o success to help them do so
a person is free to make an unwise decision and this will not in and of itself indicate a lack of capacity
any intervention must be necessary that minimises restriction of person’s rights and freedom of action and need to respect persons dignity, integrity, privacy and autonomy
any intervention must give effect in so far as is practicable to past, and present will and preferences of person
capacity HSE guidelines 2022
Best practice favours a “functional” or decision-specific approach to defining decision-making capacity;
must be issue specific and time specific
depend on patient’s ability to comprehend, reason and express choice regarding information about specific decision
best practice and international human rights standards favour “supported decision-making”
roles of assisted decision-making capacity
decision-making assistance
co-decision maker
enduring power of attorney
advance healthcare
decision-making representative
what is the decision making assistant
lowest and least formal tier
appointed by person who considers their capacity may be shortly be in question
relevant decision set out in a decision making assistance agreement
function of decision making assistant
assist to obtain relevant information
explain relevant information
ascertain and help appointer to communicate will and preferences
assist appointer to make and express decisions
help to ensure that decisions implemented
limitations of a decision-making assistant
The appointer still makes the decision
No capacity assessment required
Notified to but not formally registered with the Decision Support Service
what is the co-decision maker
Mid-tier, more formal support
Appointed by a person (‘appointer’) who considers that his or her capacity is or may shortly be in question
Co-decision-maker is a relative or friend in a pre-existing relationship of trust
function of co-decision maker
advise appointer, helping to obtain and understand information
ascertain and help appointer to communicate will and preferences
make a relevant decision jointly; may not include making gifts
make reasonable efforts to ensure that decision is implemented
what is the decision-making representation
Court makes a declaration that relevant person lacks capacity
the court can appoint a decision-making representative
role of decision making representative
be a substitute decision-maker.
AHD meaning
advance healthcare directives
ethical rational for AHDs
respect for autonomy acknowledges and protects the right
allow a person to make a legally binding refusal of treatment and to make treatment requests.
forms of advance healthcare decision making definition
an adult’s written statement setting out type & extent of treatment to which adult consents to or refuses if adult losses capacity to make treatment decisions
the purpose of forms of advance healthcare decision making
A refusal of treatment set out in an advance healthcare directive shall be complied with if:
directive maker lacks capacity to give consent to treatment
treatment refused is clearly identified in directive
circumstances in which refusal of treatment is intended to apply are clearly identified in directive
who can make an AHD
A relevant person who has attained the age of 18 years and who has capacity is entitled to refuse treatment for any reason (including a reason based on his or her religious beliefs) even if refusal may be
an unwise decision,
not to be based on sound medical principles,
or
may result in death
