Week 5: Ethical and Legal Issues

Question 1

Privacy

Answer 1

• ‘right to be left alone’

- needed for self-reflection and self-determination

Question 2

privacy and confidentiality

Answer 2

• clients may waive privacy with health professionals if considered in best interests
• professionals may interfere in life of client regardless of best interests where harm of self or others is an issue (obligation of confidentiality)

Question 3

privacy vs. confidentiality: legislation?

Answer 3

privacy is instilled in legislation but confidentiality isn’t - it is a part of ethics.

Question 4

when dealing with privacy and confidentiality it is essential to always be ??

Answer 4

TRANSPARENT

- talk to the client about what they are comfortable for you to share.

Question 5

informed consent reflects the ethical principle that a patient has ??

Answer 5

the right to decide what is appropriate for them, taking into account their personal circumstances, beliefs and priorities

Question 6

do clients have the right to accept or decline the offer of certain healthcare and to change that decision?

Answer 6

YES.

it is informed consent to do so.

Question 7

informed consent is underpinned by what principle of SW.

Answer 7

self-determination

Question 8

what body looks after working with clients with impaired decision making capacity?

Answer 8

queensland civil and administration tribunal (QCAT)

Question 9

capacity definition: a person must be able to?

Answer 9

1. understand the nature and effect of decisions about a matter
2. freely and voluntarily make decisions (no undue influence)
3. communicate the decision in some way

Question 10

out of the 3 elements of defining capacity, if a person is unable to carry out a part of this process, does the adult have impaired decision making capacity?

Answer 10

yes,

you don’t need all 3 to be considered impaired for decision making

Question 11

can social workers assess capacity?

Answer 11

No. but they play a key role in identification. they must understand and guide the process to ensure that legal requirements are met and that the patient’s best interests are served.

Question 12

capacity: what is decision specific?

Answer 12

• what kind of health intervention
  e. g. someone w/ impaired capacity can maybe decide about something small (flu vaccine), but unable to decide about something big (major surgery)

Question 13

capacity: domain specific?

Answer 13

domain: finances, housing, life elements
example: can make decision about going on holiday but can’t make decision about buying house.

Question 14

capacity: time specific?

Answer 14

• example: psychosis, doesn’t last forever

example: coma, may not last forever but can the decision be held off until they can make a decision?

Question 15

what SW can do if they can’t assess impaired capacity?

Answer 15

refer to doctor, psychologist, neuro etc. who can determine

Question 16

first step in dealing with patient who may have impaired capacity.

Answer 16

• assume capacity!!!

- refer to people who can determine

Question 17

important tips for working with patients with impaired capacity **

Answer 17

• intervening/ substitute decision making is a LAST RESORT (don’t take away right to inform their own lives)
• working to respect how they want to live their lives

Question 18

if someone doesn’t have the capacity to make a decision what happens?

Answer 18

1. QCAT appoints a guardian or administrator
2. if there’s no family = public trustee does administration
3. office of the public guardian - guardianship

Question 19

where can i get advice about guardians/administrators/ people who abuse EPOA?

Answer 19

Queensland Civil and Administrative Tribunal (QCAT)

Question 20

when might you refer to QCAT? (remember: substitute decision making is a LAST RESORT)

Answer 20

• nobody in the adults life.
• conflict between decision makers
• adult made EPOA without capacity
• financial/ emotional/ physical abuse?

Question 21

what to remember before referring to QCAT

Answer 21

• substitute decision making is a last resort
• discuss with supervisor and team
• it is intrusive

Question 22

difference between guardian and administrator

Answer 22

• guardian is for general decisions NOT financial ones

- administrator makes financial decisions

Question 23

what is power of attorney

Answer 23

• document giving another person the authority to make personal and/or financial decisions on your behalf

Question 24

2 types of power of attorney.

Answer 24

1. general power of attorney.

2. enduring power of attorney.

Question 25

general power of attorney:

Answer 25

make financial decisions for a SPECIFIC PERIOD OR EVENT (e.g. overseas?)

Question 26

enduring power of attorney

Answer 26

• appoint substitute decision maker while you have capacity to make decisions when you don’t have capacity.

Question 27

when does power of attorney come into effect

Answer 27

• you can make a date, if not - it starts immediately

- starts when you lose capacity

Question 28

if a person has impaired capacity and no EPOA, the law does what?

Answer 28

the law automatically grants power to

1. spouse
2. primary carer over 18
3. close friend or relative over 18.
4. last resort: public guardian.

Question 29

what is advanced health directive (AHD)

Answer 29

• “living will”
• gives instructions about future health care.
• in effect ONLY if cognitive health deteriorates/ unable to make decisions.
  e. g. in the future if i have a stroke i will use an AHD to say I don’t want to be resuscitated.

Question 30

when working with decision making in practice, you must consider:

Answer 30

1. the decision to be made
2. individual capabilities, impairments and wishes (understand, express, act)
3. environment: (opportunities, constraints, support, resources)