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Legal and Ethical Issues Flashcards

1
Q

Often the laws and ethics ovelap, as their concerns are similar but their scopes and processes are different

A
  • Blended into common standards of conduct and almost w/out exception, what constitutes a breach of ethics will constitute a breach of the law and vice versa
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2
Q

LAW

A
  • Law→ foundation of statutes, rules, and regulations that govern people
    • GOAL→ resolve disputes w/out violent action, and protect citizen’s health, safety and welfare
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3
Q

Ethics

A
  • Ethics→ covers the analysis and employment of concepts such as right, wrong, good, evil, and responsibility
    • Professional ethics provide rules by which practitioners decide HOW they act toward their pts, other prof’s, and one another
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4
Q

PT Code of Ethics

A

Document in Notability

READ IT!!!!!

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5
Q

Ethical Terms:

Ethics

A

Systematic reflection and analysis of morality

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6
Q

Ethical Terms:

Morality

A

Morality is concerned w/ relations bw people and how we can live in peace and harmony

*Human values

*Conduct

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7
Q

2 Subgroups of Morality

A
  1. Duties
    1. Moral responsibilities or demands
      1. they stem from specific social relationships
        1. Ex. maintaining confidentiality
  2. Rights
    1. The entitlement to act in a certain way.
    2. If you have the right to do something, then someone has the duty to act on that
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8
Q

Ethical Principles:

Beneficence

A
  • Promote GOOD
  • To be in the pos. to bring about good in your interactions w/ pts/clients
  • Bring about a positive good
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9
Q

Ethical Principles:

Nonmaleficence

A
  • First, do no harm
  • Refrain from doing harm to yourself or to others
  • Thought to be a nexus of trad. healthcare ethics and is often attributed to the author of the Hippocratic Oath
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10
Q

Ethical Principles:

Fidelity

A
  • Promise-keeping
  • Principle of Fidelity comes from the Latin root, fides, which means faithful
  • Being faithful to pt means meeting the pts reasonable expectations
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11
Q

Ethical Principles:

Justice

A
  • Fair distribution
  • The duty to be treated fairly and w/out bias
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12
Q

Ethical Principles:

Autonomy

A
  • Duty to respect persons and their rights of self-governance and self-determination
    • Sometimes ethical principles are @ odds w/ ea. other
    • Respect for older adults autonomy may be in conflict w/ the therapists desire to prevent harm or do good

*Be the BEST you can be!!!

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13
Q

Ethical Dilemmas in Geriatrics

DNR

Principles related to this:

A

Autonomy

Fidelity

Nonmaleficence

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14
Q

Ethical Dilemmas in Geriatrics

DNR

What is it?

A
  • form of an Advance Directive (AD)
  • Request to NOT have CPR if a pts heart stops or if they stop breathing
    • unless given specific direcions→ you should try to help all pts whose hearts stopped/stopped breathing
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15
Q

DNR

How can pts use this?

A
  • Pts can use Advanced Directive form OR tell their Dr. that they do not want to be resuscitated.
    • DNR order put into med record
      • accepted by Drs and hospitals in ALL STATES
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16
Q

Ethical Dilemmas in Geriatrics:

Other Directives such as Living Will, Durable Power of Attorney for Health Care

Principles related:

A

Autonomy

Fidelity

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17
Q

Other Directives or

A

Document indicates w/ some specificity the kinds of decisions the pt would like made should he be unable to participate

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18
Q

Instructive Directive

A

Spells out specific decisions

Ex. Living Will

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19
Q

Proxy Directive

A

Designate a specific person to make HC decisions for them

Ex. Durable Power of Attorney for Health Care

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20
Q

Major argument for use of Instructive Directives

A

Ex. Living Will

  • allows an indiv to participate indirectly in future med care decisions even if they are unable to make informed decisions
    • extends indiv autonomy
    • ensures that future care is consistent w/ previous desires
    • helps prevent unwanted and ultimately futile invasive medical care at the end-of-life
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21
Q

Ethical Dilemmas in Geriatrics:

Withdrawing or W/holding life-sustaining interventions

Principles related:

22
Q

Ethical Dilemmas in Geriatrics:

Withdrawing or W/holding life-sustaining interventions

A
  • Right to refuse or request the w/drawal of, unwanted med tx
  • Pts also have right to change their minds about HC values and goals
  • Quality end of life care includes managing pain, avoiding prolonged process of dying, achieving self-control, relieving burdens of care, improving relationships w/ loved ones
    • NOT same as euthanasia or suicide
23
Q

Ethical Dilemmas In Geriatrics:

Ensuring Confidentiality

A
  • Principles:
    • Autonomy
  • pts need to control their HC info
    • ex. HIIPA
24
Q

Ethical Dilemmas in Geriatrics:

Breaching Confidentiality

A
  • Principles:
    • Nonmaleficence
  • Obligations to breach confidentiality may be req’d when the clinician feels that the pt is in danger (elder abuse) or pt impaired decision making abilities or safety (driving)
25
Ethical Dilemmas in Geriatrics: ## Footnote **Responding to Requests for Interventions**
* **Principles:** * Beneficence * Nonmaleficence * Justice * Autonomy * Pts make requests for medical interventions * Many are reasonable and some are **outside the standards of care** * Clinicians are **NOT obligated** to grant requests for interventions that are _not effective_ or that _violate their conscience_
26
How to **Avoid** Ethical Dilemmas ## Footnote **Effective Communication**
* elicit pts concerns via **pt interview** * give pts adequate time to discuss **goals, issues, needs** * pay attn to **sensory/cognitive impairs**
27
How to **Avoid** Ethical Dilemmas ## Footnote **Effective Communication** **\*Relationship building mnemonic: PEARLS**
* **P:** Partnership * **E:** Empathy * **A:** Apology * **R:** Respect * **L:** Legitimization * **S:** Support
28
Legal Issues in Geriatrics ## Footnote **What is a BIG ONE?**
INFORMED CONSENT
29
Legal Issues in Geriatrics: ## Footnote **Informed Consent**
* Process by which a **fully informed pt** can participate in choices about their HC * **Legally**, pt has right to direct what happens to their body and **ethically,** it is the duty of the HCP to **involve** pt in that HC
30
It is gen'ly **accepted** that **complete informed consent** includes a discussion of the following:
* alternatives to proposed intervention * risks, benefits, uncertainties related to ea alternative * assess of **pt understanding** * **acceptance** of the intervention by pt
31
Legal Issues in Geriatric Practice: ## Footnote **Patient Self-Determination Act**
* Most hospitals, nursing homes, home health agencies, and HMO's routinely provide info on **advanced directives** @ the time of admission * **Req'd to do so under a federal law called Patient Self-Determination Act (PSDA)**
32
W/ the PSDA, pts can specify if they want to accept or refuse medical care…
* Can ID a **legal rep (HCPOA)** for urgent HC decision purposes * Pts wishes have been **clearly doc'd for future care** * Guaranteed in the 14th Amendment
33
Legal Issues in Geriatric Practice ## Footnote **Nursing Home Care Quality** **Omnibus Budget Reconciliation Act of 1987** **Ex. using restraints**
* Brought about landmark **quality assurance** to the nursing home industry under the **Medicare and Medicaid sections of SSA** * MDS * Phys/chem restraints * Resident abuse * NH staffing and nursing aide training * **75hrs for Cert** * State inspection + enforcement
34
Elder Abuse NOTE
YOU ARE _REQUIRED_ TO REPORT IT!!!
35
Elder Abuse ## Footnote **Who are the perpetrators 90% of the time?**
Family members\*\*\*
36
90% perpetrators in **elder abuse** are **family members** ½ of perps are\_\_\_\_\_, \_\_\_\_
Adult children spouses
37
**Freq forms of elder abuse**
* Neglect→ 48.7% * Emotional/psych abuse→ 35.4% * Financial exploitation→ 30.2% * Phys abuse→ 25.6% * Abandonment→ 3.5% * Sexual abuse→ .3%
38
Elder Abuse: ## Footnote **Legal Issues**
* All states have some form of elder abuse prevention laws * Laws/defs vary but all states have reporting systems * **Adult Protective Services (APS)** * receive and investigate reports of **suspected elder abuse** **\*NOTE:** Better to say something and be **wrong** vs. NOT reporting at all!!!
39
Elder Abuse Types: ## Footnote **Sexual abuse**
* Non-consensual sexual contact * Also sexual contact w/ person incapable of giving consent
40
Elder Abuse Types: ## Footnote **Abandonment**
Desertion @ institution, public place or responsibility
41
Elder Abuse Types: ## Footnote **Physical Abuse** **Ex. Wife who's husband has dementia**
* Non-accidental phys force results in injury * Willful infliction of phys pain or injury that may result in bodily injury, phys pain or impair
42
Elder Abuse Types: ## Footnote **Financial or Exploitation Abuse**
* Unauthorized use of funds or property * ex. access to bank acct * May involve theft or conversion of money or property accomplished by force, misrepresentation or other legal means
43
Elder Abuse Types: **Neglect** 2 Types
1. Active Neglect→ “I'm not caring for you” 2. Self Neglect→ Stop caring for yourself
44
Active Neglect
“I'm not caring for you” * Failure of **caretaker** to provide goods or services necessary to avoid phys harm, mental anguish or mental illness
45
Self Neglect
Not caring for yourself * Failure of **individual** to care for themself
46
Elder Abuse: * *Emotional/Psychological Abuse** * *\*not often intentional**
* Infliction of mental anguish by intimidation, verbal threats, humiliation, isolation * **frustration often involved** * Ex. progressive cond's, palliative decline
47
Elder Abuse ## Footnote **Spotting the Signs Resources**
see pics
48
Detecting Abuse in Elderly Signs to look out for w/: **Older adult vs. Abuser**
* **Older Adult** * ashamed * confused * concerned about living in nursing home * **Abusers** * answer all questions * cancel appts
49
Elder Abuse Detecting Elder Abuse More on the **abused person**
* won't come out and say their being abused * they change how they act * **can be misinterpreted as confusion\*\*\*** * **actively changing behavior due to abuse**
50
Elder Abuse ## Footnote **Reporters of abuse** **\*ANY HCP is obligated to report!!!!**
* HCP * family members * social work * friends/neighbors * victim * caregiver * law enforcer * anonymous * Me, the student\*\*\*\*
51
Elder Abuse ## Footnote **PT Involvement**
* Interview elder in **private** (attempt to) * 60% all reported cases are **substantiated** aka **actual issue!!!** * MUST doc reports and abide by state laws * Be aware of protected services and resources for intervention and advocacy * **NJ HOTLINE FOR ELDER ABUSE** * **800-792-8820**
52
Signs of Nursing Home Abuse
* Unusual bruising * Sudden changes in Wt. * Staff refuses or delays access to see loved one * Staff monitoring visits or employees refusing to leave room during visits

Geriatric PT (7 decks)

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