December 19, Online Journal of Issues in Nursing. Available: www. Ethical issues are central to any discussion or reflection on aging and health care. Thus, the focus of this column is to examine select ethical issues in these five articles on aging. Thus, the Code is applicable to us as we work with the aged, whether we make a home visit, administer a medication, answer a call light, develop a policy, or supervise a student.
We begin the column with an overview of some of the ethical issues that are explicitly and implicitly discussed in each of the five articles and then examine how the ANA Code can inform and guide us with the ethical issues outlined. The article by Bennett and Flaherty-Robb paints a broad picture of four issues affecting the health of older persons: lack of resources; scarcity of providers; financial barriers; and cultural barriers and biases.
While there are many ethical problems that can be discussed within the context of these four issues, cultural biases stand out because nurses can personally examine these biases and change them in our daily practice. As the two preceding authors note in their article, stereotyping is common. Nurses are not immune to stereotyping and, thus, must examine their own beliefs and values about aging. Do nurses and the nursing profession have their own biases about aging?
How do we react when we hear biases expressed by nurses or other health care workers or by families or by the elderly themselves?
How much does age bias influence our decision to withhold treatment or informed consent? In their article, Edlund, Lufkin, and Franklin address some of the problems related to long-term care in the US health care system.
At first glance one may not consider the individual ethical implications imbedded in this topic. The article authors, however, point out the ethical duty nurses have to educate the public and at the same time keep themselves knowledgeable about long-term care. But are nurses as educated as they should be about long-term care? Have you heard nurses say, "I do not understand Medicare"?
Have you heard acute care nurses publicly find fault with long-term care nurses or vice versa? Do you listen for and correct misperceptions such as, "Long-term care is nursing home care," or "Nursing homes are where people go when nobody wants you"? Even in pediatrics and maternity, where one assumes a younger population, we see in developed and in developing countries a rising number of grandparents who are primary caregivers for children. While the educational process may have fallen short, are nurses keeping up with the gerontological and ethical literature as it applies to the areas of nursing in which they work?
As Young discusses the challenge of resource allocation, she also notes ethical dilemmas. Specifically, she mentions end-of-life care and the decision to treat against the wishes of the dying person.
In our professional or personal lives, have we found family members or other health care workers who persuaded us to prolong or start a treatment when it was expressly against the wishes of the dying person?
Or have we been in a situation where we failed to ask in a timely manner what kind of care that dying persons want? The last article by Hartman-Stein and Potkanowicz addresses the behavioral components of successful aging.Elder abuse is an increasingly intangible phenomenon that has created numerous ethical issues for care teams and caregivers.
Although different studies have concentrated on various ethical issues regarding abuse, no study has arrived at a comprehensive conclusion. Therefore, the present study aimed to determine the existing ethical challenges in this context. They were able to find articles that met the inclusion and exclusion criteria, and finally selected 15 articles based on the predesigned questions. The findings were classified in five subtitles as follow: 1 the common definition of elder abuse, 2 a comprehensive legislation on elder abuse, 3 comprehensive ethical principles about elder abuse, 4 ethical considerations regarding patients without competency, and 5 reporting and sharing information about elder abuse.
Nowadays, elder abuse is a serious problem in many countries. Cultural and religious differences are the reasons for lack of a common definition and legislations, which comprises the biggest obstacle to protecting the rights of elderly people.
It is clear that ethical principles should be respected as far as a person has competency. Furthermore, localization of clinical guidelines related to this issue leads to proper functioning of health care providers, especially nurses as the first line of treatment.
Abuse is among the most common challenging issues in both developed and developing countries around the world 12. Presently, elder abuse is the most covert form of mistreatment that involves issues such as health, justice, ethics, and human rights 3. Different definitions have been provided for abuse over time 5. Elder abuse may refer to an act or absence of a proper act that will cause harm or suffering to an older person, and it happens in a relationship that normally requires trust, and may be performed only once or several times 126.
While little information is available about elder abuse especially in developing nations, it is predicted to be on the rise in countries that experience the phenomenon of population aging. According to WHO estimations, one out of every six elderly people experiences abuse, and only 1 out of 24 abuse cases is reported 1. Since awareness of abuse is influenced by knowledge, expertise and preparedness of caregivers 37the care team and nurses as the first line of treatment are responsible to identify and report mistreatments and support vulnerable populations such as the elderly 89.
Intervention in case of abuse is accompanied by ambiguity and ethical challenges, because lack of professional principles leads to personal, legal and ethical concerns However, it is difficult for nurses and other members of the care team to perform a successful intervention for an elderly who is willing to stay in the abusive situation Also, this phenomenon causes challenges for nurses and other care team members when legal commitments are not consistent with ethical principles Questions and challenges in this context include: Are there any comprehensive ethical principles and regulations?NursingCenter Blog.
Continuing Education More. An Ethical Perspective on Elder Abuse. Share this on. Nurses have a duty to report and to protect vulnerable populations including older adults. Abuse in the family and intimate partner abuse are often complicated because older adults are struggling with conflicting social, cultural, religious, or other pressures to continue living with their abusers Finfgeld-Connett, D. In order to prevent harm to your clients at risk for abuse, nurses must carefully assess the ethical implications from the perspective of older adults, and then develop the best plan to intervene.
Social and Cultural When deeply rooted cultural stigma about broken families exists, women may endure decades of abuse to portray an image of family unity rather than taking assistance to ensure their own personal safety Finfgeld-Connett, D. There are reports of elders whose spiritual advisors have encouraged them to remain in abusive relationships rather than to leave Finfgeld-Connett, D.
Some elders who have been abused feel trapped and unable to leave the relationship because of guilt over dependency of their spouse for shared income or fear for their own ability to provide for themselves Finfgeld-Connett, D. If there is a situation when a client is in eminent danger or has been injured, there should be immediate action to obtain treatment and to remove weak or disabled individual to a safe location.
In non-urgent situations, nurses should take steps to help their clients to seek support from the community including counseling services, religious organizations, senior centers, or support groups to reduce their risk for being abused. Journal of the American Geriatric Society, —15, doi: Intimate partner abuse among older women: Qualitative systematic review.
Clinical Nursing Research, 23 6 — Olson, J. Elder Abuse: Speaking out for justice. Comments Blog post currently doesn't have any comments. Log in to leave a comment Login or Register.Skip to content. Law and Aging. The pdf for the issue in which this article appears is available for download: BifocalVol. For attorneys, elder abuse is often inextricably linked with ethical dilemmas. Wherever a lawyer learns or suspects that elder abuse is present, that lawyer is faced with a host of difficult questions and possible responses.
Moreover, given that one out of every ten people ages sixty and older who lives at home suffers abuse, neglect, or exploitation, this issue is highly relevant to all attorneys serving the older adult population. These observations reflect the attitudes of elder law attorneys across the country. In a national study, elder law attorneys listed complex ethical issues and elder abuse as two of the most frequent issues that arise in their practices.
These are also two of the areas where attorneys most feel that they need additional continuing legal education. Nina A. Elder L. Difficult ethical situations are often much less difficult when attorneys prioritize educating themselves about the frameworks that should govern their conduct and structure their practices with an eye toward protecting themselves and their clients. Consider the following scenario:.
Chelsea speaks for her mother during the intake and advises the attorney that she will become the sole beneficiary under the new will, and that it will effectively exclude her two brothers.
Hillary, at age seventy-two, seems physically mobile and healthy, but seemed slightly confused or forgetful when the conversation turned to the specifics of her financial matters. She seemed to have a dependent but caring relationship with her daughter. The attorney agrees to make the changes to the will, and set up a time to review the documents with Hillary. But as they leave, the attorney overhears Chelsea tell an associate to send the bill to her. Should the attorney accept payment from Chelsea?
An attorney must first ascertain who the client is in this scenario. Therefore, she is the client. The Modern Rules of Professional Conduct generally prohibit an attorney from accepting payment for legal services from a third party. First, the attorney must obtain written consent from the client.
In this case, Chelsea has taken control of the relationship by instructing the attorney. Here, the attorney has not properly established attorney-client confidentiality by meeting with Hillary alone and giving her the opportunity to disclose any information she wants to share. Therefore, based on the facts above, the attorney may not accept payment from Chelsea. There are several best practices that elder law attorneys can put in place as part of their initial client intake that will help prevent situations like the one described above.
First, an attorney should have the universal practice of meeting with a new client alone. This practice can be explained in advance to relatives or friends who call on behalf of new clients. During this initial meeting, an attorney should discuss the fee structure and any other basics of the attorney-client relationship. This should include a discussion about any family members, friends, or caregivers that the client would like to assist or advise them over the course of the representation.
This new law, enacted in Septemberrecognizes the critical role that supportive caregivers provide.NCBI Bookshelf. What are the ethical goals of elder abuse prevention? What are the ethical challenges and issues in preventing and intervening in abuse and neglect? Workshop panelists discussed these issues in the context of providing care and services, and opportunities for prevention. Workshop speaker Susan Lynch from the Department of Justice suggested that the goals of elder abuse prevention are to prevent unnecessary suffering, maintain autonomy, and maintain quality of life.
Within this context, she laid out four principles to consider in elder abuse prevention:. Autonomy is the right to self-determination, independence, and freedom. Autonomy expresses the concept that professionals have a duty to treat the person according to the person's desires, within the bounds of accepted treatment, and to protect the individual's confidentiality. Beneficence requires that health care providers do good for individuals under their care by understanding the individual from a holistic perspective that includes the individual's beliefs, feelings, and wishes as well as those of the individual's family and significant others.
Nonmaleficence is the requirement that health care providers do no harm to their patients and that they protect their patients from harm. In making decisions on which ethical issues to focus its resources, Lynch noted that the Department of Justice, with funding support from the Department of Health and Human Services, developed a concept map of the field of elder abuse.
Through this process, the key ethical issues that were identified were brain health and function, elder abuse reporting, provisions under the Health Insurance Portability and Accountability Act of HIPAAand long-term care quality and abuse prevention. Within the area of brain health and function, the primary concern is an individual's decision-making capacity and competency.
Lynch defined decision-making capacity as the ability to understand the nature and consequences of different options, to make choices among those options, and to communicate that choice.
Decision-making capacity is required in order to give informed consent. Such capacity may fluctuate over time, given the state of health of the individual as well as the particular issue.
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Another issue related to brain function and health is the notion of competency. Competency is defined legally and determines if an individual is fit and qualified to give testimony or executive a legal document. In the United States, the law presumes all adults are competent and have decision-making capacities to make health decisions unless deemed otherwise in court.
Lynch discussed ethical issues within the legal system about the capacity of a vulnerable adult to testify in an elder abuse case. She noted that a lack of competency could be used as a defense litigation strategy to preclude testimony from victims or witnesses of abuse.Not a MyNAP member yet?
Register for a free account to start saving and receiving special member only perks. R esearch on elder abuse and neglect poses a multitude of challenges. Besides presenting methodological and practical difficulties, studying maltreatment of older people raises formidable ethical and policy problems. Two general features of the research account for these problems. First, the study population includes older persons with various mental, physical, and social vulnerabilities. Second, the research involves collecting information that could have negative legal, financial, and social consequences for the older persons and caregivers being studied.
The ethical and policy analysis is further complicated by an absence of regulatory guidance and ethical consensus regarding the appropriate procedures to govern research involving persons who lack the ability to decide about research participation. A similar lack of guidance exists regarding the conduct of research in nursing homes and other residential facilities. Finally, current policy and ethics fail to resolve many questions about the appropriate approach to research seeking legally and socially sensitive information.
In this paper, I address ethical and policy issues raised by research on elder abuse and neglect. I use as a framework for ethical analysis the Belmont Report, a document that identifies ethical principles and guidelines. Rebecca Dresser, J. My analysis reviews general issues relevant to research on elder abuse and neglect. Because states vary in their approaches to regulating disclosures of private information, professional reporting duties, nursing home operations, and other relevant topics, issues raised by individual research projects must be separately evaluated by local institutional review boards IRBs and attorneys.
The Belmont Report describes the characteristic features of research involving human participants and articulates three ethical principles that apply to such research. These principles are 1 respect for persons, 2 beneficence, and 3 justice. The principle of respect for persons underlies the requirement for informed consent to study participation.
The principle of beneficence underlies the requirement to evaluate and balance risks and expected benefits in human studies. The principle of justice addresses fairness in selection of research participants. Provisions in the Common Rule incorporate these Belmont Report principles and requirements. Institutional review boards rely heavily on the Belmont Report and Common Rule when they evaluate research proposals.
Thus, studies on elder abuse and neglect must take into account the concepts and considerations in these documents. Although the Department of Health and Human Services has adopted additional regulations to cover certain populations deemed especially vulnerable in research, it has no special regulations governing research involving older persons, persons with impaired decision making capacity, or residents of nursing homes and other institutions.
Various individuals and groups have, however, made recommendations addressing ethical issues with particular relevance to these populations. In addition, the Common Rule contains a few provisions that specifically bear on vulnerable populations in research.
In considering the issues raised by research involving elder abuse and neglect, one should keep in mind certain characteristics of U.Skip to content. Law and Aging.
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The flyer is available for download. If you have questions about the Pocket Guide or the Desk Guide, please contact the Commission at aging americanbar. In some cases, a fee may be charged. Search ABA. Close Search Submit Clear. Popular Links Search. Overview Pocket Guide. Provides brief explanations of: legal concepts, documents, and tools that may be misused to commit elder abuse or used properly to remedy it, and issues and actions that justice system professionals should consider if they suspect elder abuse has occurred.