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Geriatric PT > Legal and Ethical Issues > Flashcards

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
Q

Ethical Dilemmas in Geriatrics:

Responding to Requests for Interventions

A
  • 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
Q

How to Avoid Ethical Dilemmas

Effective Communication

A
  • elicit pts concerns via pt interview
  • give pts adequate time to discuss goals, issues, needs
  • pay attn to sensory/cognitive impairs
27
Q

How to Avoid Ethical Dilemmas

Effective Communication

*Relationship building mnemonic: PEARLS

A
  • P: Partnership
  • E: Empathy
  • A: Apology
  • R: Respect
  • L: Legitimization
  • S: Support
28
Q

Legal Issues in Geriatrics

What is a BIG ONE?

A

INFORMED CONSENT

29
Q

Legal Issues in Geriatrics:

Informed Consent

A
  • 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
Q

It is gen’ly accepted that complete informed consent includes a discussion of the following:

A
  • alternatives to proposed intervention
  • risks, benefits, uncertainties related to ea alternative
  • assess of pt understanding
  • acceptance of the intervention by pt
31
Q

Legal Issues in Geriatric Practice:

Patient Self-Determination Act

A
  • 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
Q

W/ the PSDA, pts can specify if they want to accept or refuse medical care…

A
  • 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
Q

Legal Issues in Geriatric Practice

Nursing Home Care Quality

Omnibus Budget Reconciliation Act of 1987

Ex. using restraints

A
  • 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
Q

Elder Abuse NOTE

A

YOU ARE REQUIRED TO REPORT IT!!!

35
Q

Elder Abuse

Who are the perpetrators 90% of the time?

A

Family members***

36
Q

90% perpetrators in elder abuse are family members

½ of perps are_____, ____

A

Adult children

spouses

37
Q

Freq forms of elder abuse

A
  • Neglect→ 48.7%
  • Emotional/psych abuse→ 35.4%
  • Financial exploitation→ 30.2%
  • Phys abuse→ 25.6%
  • Abandonment→ 3.5%
  • Sexual abuse→ .3%
38
Q

Elder Abuse:

Legal Issues

A
  • 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
Q

Elder Abuse Types:

Sexual abuse

A
  • Non-consensual sexual contact
  • Also sexual contact w/ person incapable of giving consent
40
Q

Elder Abuse Types:

Abandonment

A

Desertion @ institution, public place or responsibility

41
Q

Elder Abuse Types:

Physical Abuse

Ex. Wife who’s husband has dementia

A
  • 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
Q

Elder Abuse Types:

Financial or Exploitation Abuse

A
  • 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
Q

Elder Abuse Types:

Neglect

2 Types

A
  1. Active Neglect→ “I’m not caring for you”
  2. Self Neglect→ Stop caring for yourself
44
Q

Active Neglect

A

“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
Q

Self Neglect

A

Not caring for yourself

  • Failure of individual to care for themself
46
Q

Elder Abuse:

  • *Emotional/Psychological Abuse**
  • **not often intentional**
A
  • Infliction of mental anguish by intimidation, verbal threats, humiliation, isolation
    • frustration often involved
      • Ex. progressive cond’s, palliative decline
47
Q

Elder Abuse

Spotting the Signs Resources

48
Q

Detecting Abuse in Elderly

Signs to look out for w/:

Older adult vs. Abuser

A
  • Older Adult
    • ashamed
    • confused
    • concerned about living in nursing home
  • Abusers
    • answer all questions
    • cancel appts
49
Q

Elder Abuse

Detecting Elder Abuse

More on the abused person

A
  • 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
Q

Elder Abuse

Reporters of abuse

*ANY HCP is obligated to report!!!!

A
  • HCP
  • family members
  • social work
  • friends/neighbors
  • victim
  • caregiver
  • law enforcer
  • anonymous
  • Me, the student****
51
Q

Elder Abuse

PT Involvement

A
  • 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
Q

Signs of Nursing Home Abuse

A
  • 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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