Legal etic copy

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 2
INTRODUCTION
 Physician and other health care providers
use medical and scientific knowledge
along with clinical judgment and expertise
to provide quality healthcare to keep you
functioning and independent for as long as
possible. However, in some situations,
providing the best care requires choosing
among conflicting responsibilities, values,
and principles

LEGAL AND ETHICAL ISSUES
Respecting Your Choices
 Informed consent
 Decision-making capability
Judging the Capacity to
Make Decisions
Advance directives
 Living wills
 Durable power of attorney for
health care
 Problems with advance directives
 The importance of communication
Choosing a surrogate decision
maker
Acting in your best intertest
Preventing harm
 Placement issues
 Abuse of elderly
 Guardianship
Decision of people in
nursing home
Life-sutaining treatment
DNR orders
Withdrawing treatment
Tube feeding
Active euthanasia
Assisted suicide

LEGAL AND ETHICAL ISSUES
Respecting Your Choices
Informed consent
Decision-making capability

Informed consent
 Informed consent is a legal doctrine
stating that you have the power to choose
among medically reasonable plans for
your care.
 Informed consent for research

Cont..
Informed consent requires effective communication
between you and your doctor, and to be able to make
informed choices, you need to discuss many things (as
often as needed), including the following:
 your diagnosis
 the overall outlook
 the nature of the recommended test or treatments
 the various alternatives
 the risks and benefits of each alternative
 likely outcomes of each alternative

Decision-making capability
The process of informed consent makes sense
only for people who have the ability to make
informed decisions.
This does not change unless the individual is
determined to be "incompetent or incapacitated"
by a court of law.
The terms "incompetent or incapacitated" are
legal terms and apply specifically to legal cases
in court

Judging the Capacity to Make
Decisions

Advance directives

Living wills
Laws or legal opinions that authorize living wills.
These are often called natural death, death with
dignity, or right-to-die laws.
Generally, these laws allow you to direct health
care providers to withhold or withdraw treatment
that is keeping you alive if you become
terminally ill and are no longer capable of
making decisions.

Durable power of attorney for
health care
The durable power of attorney for health care is
more flexible and comprehensive than a living
will.
It allows you to designate a surrogate decision
maker, presumably a friend or relative, to make
the medical decisions if you lose the ability to
make them yourself.
You give the surrogate your informed consent (or
refusal) while you are still capable.

Problems with advance
directives
Advance directives have limitations. For example,
an older adult may not fully understand
treatment options or appreciate the
consequences of certain choices.
Sometimes, people change their minds after
expressing advance directives and forget to
inform others. Many times, advance directives
are too vague to guide clinical decisions.

The importance of
communication
Good communication can resolve many problems
posed by advance directives. You and your
health care provider should routinely share
information on advance directives.
A straightforward question you can ask to open the
topic is: "Can we talk about how decisions will be
made for my medical care in case I become too
sick to talk to you directly?"

Choosing a surrogate decision maker
Traditionally, family members act as surrogate decision
makers (or stand-ins) for incapacitated individuals,
because most probably they best know the person’s
preferences and will act in their best interests.
Family members are also normally consulted by the health
care provider. However, the health care provider may
sometimes decide that decisions by family members are
questionable because of conflicting personalities, values,
or interests.
In addition, some family members may be estranged or
unwilling to make decisions, or they may disagree
among themselves. In other cases, older adults have no
surviving relatives.

Acting in Your Best Interests
If you have not given advance directives or
appointed a surrogate decision maker, health
care providers may have to base decisions on
what is in your "best interest," by weighing the
benefits and possible problems of treatment.
This is a complicated and often controversial
process that requires dealing with such personal
factors as pain and suffering, safety, and loss of
independence, privacy, and dignity

Preventing Harm
Health care providers have a duty to use
their expertise for the benefit of the people
in their care.
However, you retain the right to refuse
treatments that your health care provider
considers to be in your best interest.

Placement issues
Preventing harm to an individual is often
raised in decisions to place someone in a
nursing home.
An older adult may wish to remain at home,
but family member or caregivers may
override this decision if they believe that
living independently is not safe.

Abuse of older adults
Family members or other caregivers can
sometimes become abusive for a variety
of reasons.
These may include feeling overwhelmed
and burnt out by caregiving
responsibilities, lacking appropriate
caregiving skills, or having no break from
caregiving.

Guardianship
Some older people cannot manage their finances
or provide themselves with food and shelter.
Sometimes, relatives or friends make informal
arrangements to help these individuals.
In other cases, it is necessary to ask the courts to
appoint a guardian, as when property must be
managed or sold to pay for long-term care.

Decisions for people in nursing homes
Nursing-home residents may need additional
safeguards when decisions about life-sustaining
treatments are made.
These people may not have close relatives to act
on their behalf, and their relationships with
health care providers may be superficial.
There are also fewer caregivers involved in
decisions at nursing homes compared with
hospitals.

Life-Sustaining Treatments
Advances in medical technology have often
created medical dilemmas.
For example, health care providers may be able to
successfully treat a sudden complication in a
seriously ill person, but restoring function and
improving the underlying disease may be
impossible.
In such a situation, treatment that only prolongs life
may be appropriately withheld.

Cont..

Do-Not-Resuscitate Orders
 Cardiopulmonary resuscitation (CPR) may be an
effective treatment for unexpected sudden
death, but it is not effective for people whose
death is expected.
 Older adults generally do poorly after CPR
because of serious illnesses and decreased
functional status.

Withdrawing Treatment
Strange emotional feelings are a natural part of
decisions to stop, withdraw, or withhold care.
We are torn between the impending sense of loss
of our loved ones and our desire that their
suffering be relieved and their dignity
maintained.

Tube Feeding
Tube feedings clearly benefit people who
want or agree to this treatment.
In addition, feeding provides more time to
diagnose and treat underlying conditions.

Active Euthanasia
Active euthanasia (also called mercy killing)
is illegal.
Requests for it generally arise because
individuals suffer uncontrolled pain,
demand more control over their care, or
fear abandonment

Assisted Suicide
Statistically, older white men are at a greatly
increased risk for suicide.
Most suicides are impulsive acts that are not well
thought out.
Also, people who seriously consider suicide
usually suffer from depression.
Because individuals who are incapacitated by
depression cannot make informed decisions,
family and friends are quite likely to get involved
and seek medical advice.

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