Legal & Ethical Concerns

Question 1

What is the health care consent act?

Answer 1

• Promoted individual authority and autonomy
• facilitates communication between health practitioners and clients
• ensure role for family members if client is incapable of giving consent
• ensures HCP’s have no authority to make treatment decisions on client’s behalf (outside of emergencies)

Question 2

When are nurses accountable for obtaining consent from patients?

Answer 2

• admission
• treatment
• personal support services

Question 3

Who can give consent?

Answer 3

• capable patient
• substitute decision maker of a patient not capable
• in emergency when no SDM available, no consent required

Question 4

What are forms of consent?

Answer 4

Verbal, written, implied

Question 5

Is there a age limit for consent?

Answer 5

No age limit, do not need to be 16 years old

Question 6

Can consent be withdrawn?

Answer 6

Yes, at any time

Question 7

When should nurses not proceed?

Answer 7

If there is any doubt about whether the client understands and is capable of consenting

Question 8

What information does a patient need to make an informed decision?

Answer 8

• nature of treatment
• expected benefits and risks
• expected side effects
• alternative courses of action
• likely consequences of not having the treatment

Question 9

What do SDM’s do?

Answer 9

Make decisions for patient relevant to their wishes. If their wishes are not known, SDM makes decisions in the best interest of the patient

Question 10

Hierarchy of SDM

Answer 10

1. guardian of person
2. Someone who has been named as an attorney for personal care
3. Some appointed as a representative by the CCB
4. Spouse or partner, child if 16 or older, custodial parent, relative, brother or sister
5. PGT

Question 11

What is autonomy?

Answer 11

Personal freedom to direct one’s own life as long as it does not infringe on rights of others

Question 12

What is competency?

Answer 12

• Ability to manage one’s affair overall, in a responsible matter
• ability to make decisions
• adults (18+) are presumed to be competent

Question 13

What does the judge do if someone is deemed incompetent?

Answer 13

Assigns either partial or full guardianship to a designated person

Question 14

What does capacity mean?

Answer 14

Ability to understand, make, and be responsible for the consequences of health care decisions

Question 15

Who determines one’s capacity?

Answer 15

Health care providers

Question 16

What does decision making capacity require?

Answer 16

• ability to understand consequences of refusing or consenting
• ability to understand info relevant to make a decision about an admission, treatment, or personal assistance services

Question 17

Is capacity based on age or diagnosis?

Answer 17

No, assessed situationally

Question 18

What is advanced care planning?

Answer 18

Legal documents that allow individuals to outline preferences for medical care if they become unable to communicate decisions and will often choose a SDM

Question 19

Is advanced care plan consent? Are wishes decisions?

Answer 19

No, not consent or decisions.

Therefore patients cannot provide future consent for treatments

Question 20

How does ACP work?

Answer 20

Select SDM or appoint a power of attorney

Patient should then communicate their wishes for future care to SDM or HCP’s

Question 21

Benefits of ACP?

Answer 21

• improve quality of end of life care
• supports substitute decision makers in a difficult time
• may reduce health care costs with reduced unwanted treatment

Question 22

Barriers of ACP?

Answer 22

• patient not informed, encouraged, supported to start conversation
• patient fear of talking about death, fear of family conflict, low health literacy
• HCP lack of education and patience; rushing client to make decisions

Question 23

How do nurses support older adults with ACP?

Answer 23

1. Think
2. Learn
3. Decide
4. Communicate
5. Documentation

Question 24

What is advanced directives?

Answer 24

Legal documents that allow competent older adults to document medical care they would or would not want to receive

Question 25

What is advanced directives? What are the things it contains?

Answer 25

Legal documents that allow competent older adults to document medical care they would or would not want to receive

• DNR
• Preferences
• power of attorney/SDM
• living will

Question 26

what is a DNR order?

Answer 26

Specific type of advance directive that compels health care providers to refrain from CPR if there is no heartbeat or breathing

Question 27

What is client does not have document for DNR upon admission or with a changing health status?

Answer 27

Client will be asked to provide consent or refuse consent in an event CPR is needed

Question 28

What are living wills?

Answer 28

Also type of advance directive. Outlines person’s preferences for refusing or receiving a broad range of health treatments in the future, should they become incapacitated, unconscious, terminal illness, or end of life

Question 29

Can living wills be changed?

Answer 29

Yes, and can be revoked at any time

Question 30

What are Physician Orders for Life Sustaining Treatment directives? POLST

Answer 30

Medical directives that a health care provider fills out for an individual and signs. It’s used for emergency situations and has clear instructions for health care provides to follow without interpretation

Question 31

What is the Bill of Rights for residents in LTC?

Answer 31

Outlines rights and protections for individuals living in LTC’s