Ethics In Geriatric and Chronic Illness

Medicalization

an attitude and motivation for action that emphasizes cure over care in health care professionals relationships with patients of all ages.

Nurse Beverly Hall (2003) -sited three examples of medicalization based on her own treatment of breast cancer.
a. giving useless treatment to keep the patient under medical care

b. demeaning and undermining efforts at selfdetermination and self-care

c. keeping the patients life suspended by continual reminders that death is just around the corner, and that all time and energy left must be devoted to ferreting out and killing the disease.

Vikor Frankl (1984)

Maintained that mans search for the meaning is the primary motivation in his life.

Humans embark on the search for the meaning in order to alleviate and understand and to move toward to wellbeing.
Believed that his inner tension is a prerequisite for mental health.

Valuing the need to strive toward equilibrium and homeostasis is wrong.

Accepting that equilibrium is not necessarily always the healthiest state supports the belief that suffering should not be attacked as if it is something to eliminate at all costs.

Rather, well-being often involves the relief of suffering through the acceptance of suffering.

George Elliot -captured the philosophy with the word meliorism.

Meliorism
(negative concept)

an ethic of action oriented to toward the relief, not the acceptance, pain and suffering.

it causes doctors and nurses to work toward curing the disease and relieving suffering at all cost.

Transforming acceptance. In these instances, the goal of the nurse would be to help facilitate the patientss acceptance of the pain and suffering that cannot be changed

Chronic Illness
Erlen (2002) three fundamental concerns related to ethics and chronically ill persons.
Lack of control Suffering Access to services Patients with chronic illnesses frequently feel as if their illness are controlling them rather than feeling that they are in control of their own lives.

Suffering

the state of severe distress associated with events that threaten the intactness of the person. (Cassell, 1991)
Patient suffering is often related to 1. unrelieved pain

2. stigma of chronic illness

3. Disparities between the consequences of extending life and the quality of life that results from the ability to extend it.

Assessing the Capacity to Remain at Home

Determinations become particularly difficult when frail elders adamantly want to remain in or return to their homes, and caregivers disagree with the elders decision.

Caregiver must consider the real and perceived mental incapacities of elders and question the safety of their living situation.
If it is believed that an elder is incapacitated, an issue of elder autonmy versus caregiver beneficence may occur.

Beauchamp and Childress (2001)

Weak or soft paternalism

involves an intervention by a caregiver based on the principles of beneficence or nonmaleficence that is enacted to protect persons against their own substantially nonautonomous actions. Nonautonomous actions

are actions that are based on rational decision making

Long-Term Care
Pullman (1998)

Proposed that an ethic of dignity, as opposed to an ethic of autonomy, be used in longterm care.
Ethic of dignity

focus is on the moral character of care givers rather than on the autonomy of the recipients of care.

Divides dignity into: Basic dignity - the dignity inherent in all humans Personal dignity - evaluative type of dignity decided on by communities but which does not have to be solely tied to autonomy. Rule of justified paternalism - the degree of paternalistic intervention justified or required, is inversely proportional to the degree of autonomy present.

Elder abuse
Elder abuse includes

1. Neglect
2. Abuse, both physical and psychological

3. Financial exploitation
4. Neglect by self or caregiver

Nurses must take an active role in recognizing the abuse of elders and knowing state statues regarding the handling of elder abuse.

Guideline for meeting moral responsibility in reporting abuse

Report to:
Adult protective services
Long term care ombudsman (usually when an agency or health care provider is involved)

State licensing board (when health care provider is involved)

Law enforcement (if required under statute)

When:
Written or verbal report within 24 hours of incident

Age-Based Distribution of Health Care

There has been substantial debate among bioethicist and philosophers about the need for a societal plan to fairly distribute health care resources among different generations.

It is often vulnerable populations such as the very young (neonates) and the very old who are the focus of discussions regarding discussion regarding distribution of healthcare resources

Social justice in distributing health care goods according to age has been described as a type of rationing. Rationing-a term that fits into discussions related to crisis situations. (Moody, 1992)
based on scarcity of resources and is usually thought of as a temporary situation. -the term rationing does not accurately define a method that is appropriate to use in making most decisions regarding the distribution of health care resources.

Management of Care
Travelbee (1971) described the human to human relationship as mutually significant experience between a nurse and the recipient of care
Each participant in the relationship perceives and responds to the human-ness of the other; that is, the patient is perceived and responded to as a unique human-being-not as an illness, a room number, or as a task to be performed.

Healing (Capra,1982)
a complex interplay among the physical, psychological, social, and environmental aspects of the human condition.
-suggests a moving toward wholeness that goes beyond a single human being -it is consistent with a belief in the interconnection of all beings and the universe. -Healing does not imply curing -it involves a realization that all things cannot be fixed

End of presentation Thank you