Ethics is a fundamental part of geriatrics. Ethics, or the provision of ethical care, refers to a framework or guideline for determining what is morally good (ie, right) or bad (ie, wrong). Ethical problems arise when there is conflict about what is the “right” thing to do. This dilemma generally occurs when decisions need to be made whether or not a medical intervention should be implemented and whether or not the intervention is futile. The answers to ethical questions are not straightforward; they involve a complex integration of thoughts, feelings, beliefs, and evidence-based data. Ageism can play a strong role in these decisions. Acknowledging and acting on the wishes of the older individual are a critical component of ethical care. While ethical dilemmas are central to the practice of medicine itself, the dependent nature of the older adult and the imminence of death raise special concerns. Discussions of ethics and aging seem to focus on the roles of autonomy and cost containment, since a significant portion of the cost of delivering health care is incurred at the end of life.

1. ETHICO-LEGAL
CONSIDERATION IN THE
CARE OF OLDER ADULTS
BY: ROMMEL LUIS C. ISRAEL III

4. BILL OF
RIGHTS FOR
LONG-TERM
CARE
RESIDENTS

5. LEGAL ISSUES

6. ACT OF NEGLIGENCE,
MALPRACTICE AND OMISSION
NEGLIGENCE :
It is the failure to exercise adequate care

7. MALPRACTICE :
It is the negligence on the part of a professional
person in providing care to another person.
FOUR CONDITIONS:
# Adult to client
#a failure to meet
that duty
# an injury or
negative outcome
caused by not
meeting that duty
# actual harm or
damages suffered
by the person who
is receiving care.

8. ACT OF NEGLIGENCE, MALPRACTICE AND
OMISSION
Omission :
It occurs when something omit , that is ordered or
expected as a normal part of treatment for a client.
The rights of the elderly are abused when the family
does not give them adequate care and attention

9. INTENTIONAL TORTS
•Acts by a nurse performed with the
intent to bring about specific result.
•Assault: is an attempt or threat to
injure another person
•Battery : is unwanted or unconsented
physical contact

10. DEFAMA
TION
Written or spoken communication that
holds a person up to ridicule or scorn
and tends to harm his or her reputation.
• Libel – written defamation
• Slander – spoken defamation

11. •Violation of a
person’s right to be
left alone or to enjoy
reasonable
noninterference with
his/her life.
INVASION
OF
PRIVACY

12. ELDER ABUSE AND
NEGLECT
Elder abuse can be defined as "a single,
or repeated act, or lack of appropriate
action, occurring within any relationship
where there is an expectation of trust
which causes harm or distress to an older
person".

13. TYPES
Physical abuse: any action that causes physical pain or injury.
Psychological/ emotional abuse: The infliction of mental
anguish. Eg: ignoring, isolating, shouting
Financial/ material abuse: The illegal or improper exploitation
and or use of funds or resources.

14. Sexual abuse: Non-consensual contact of any kind
with an older person.
Neglect: The refusal or failure to fulfil a care-taking
obligation including / excluding a conscious and
intentional attempt to inflict physical or emotional
distress on the older person.

15. PREVENTION OFABUSE
To increase public awareness and knowledge of the issue.
To promote education and training of professionals and
paraprofessionals in identification, treatment and
prevention.
To further advocacy on behalf of abused and neglected
elders.
To study into the causes, consequences, prevalence,
treatment and prevention of elder abuse and neglect.

16. •

17. ADVANCE DIRECTIVES
•Advance directives are written statements of a
person’s wishes regarding medical care .
•It is a formal, legally endorsed document that
provide instructions for care(living will) or
names a proxy decision maker (durable power
of attorney)

18. ORIGIN OF ADVANCE DIRECTIVES
Patient Self-Determination Act (1991)
Purpose of the law:
To ensure the rights of individuals to ACCEPT
or REFUSE medical or surgical treatment
Health Care Institutions:
Inform the individuals about their rights to participate in
decisions about their health care and the right to make
Advance Directives

19. ETHICAL ISSUES

20. RESTRAINTS
PHYSICAL RESTRAINTS AND
CHEMICAL RESTRAINTS
• PERSUMED BENEFIT OF RESTRAINT
SHOULD BE CAREFULLY WEIGHED
AGAINST THE RISK OF COMPLICATIONS
AND THE INSULT IT PRESENT TO
PATIENTS DIGNITY
.

21. Physical restraint should be used only when the
patient is a danger for himself or others and when all
other behaviour management have been exhausted.
It creates an obligation for the professional to
attend carefully to the negative consequences of
restraint and preventing them.
Chemical restraints is by giving psychoactive
pharmacological agents. It is prescribed with caution
and only when for the clear benefit of the patient.

22. DO NOT RESUSCITATE ORDERS
• DNR are legal and binding but must be justified as
client request or be medically indicated.
• When DNR order is made , the supporting
documentation must include client’s current condition,
prognosis, summary of decision making and who was
involved.

23. Withholding and withdrawing
treatment
IT INCLUDE ACTIONS RELATED TO
CLIENT’S
right to refuse treatment
or withdraw consent for
it.

24. ASSISTED SUICIDE AND
EUTHANASIA
• Grave decision and certainly do not provide
medication to hasten death in a patient.
• Ensure that the elderly person has complete
information when asked to make a decision
regarding health care.
• It is illegal in most countries

25. MEDICAL DECISION MAKING FOR A
POTENTIALLY INCOMPETENT
PATIENT
•In incompetent ; identify
appropriate proxy
•If proxy is unavailable , use best
medical judegement while
locating proxy.

26. INFORMED CONSENT
The patient’s bills of right clearly outlines a person’s right to
information before giving consent to treatment.
The older adults and care givers have the right to all information
available or arranging for court appointment. If proxy is available,
discuss and take substituted judgements or best interests.

27. ENTERAL
FEEDING
•It is acceptable to withhold
treatment such as IV fluids,
antibiotics on request of the
appropriate proxy decision
maker when life prolongation
is no longer the appropriate
goal.

28. PATIENT OPPOSITION
TO PLACEMENT
Placing the
patient in a
nursing home
based on
patient will
Nurse remember
the rights of
patient as well as
caregiver.
When all
approaches failed
contact outside
source such as
OMBUDSMAN or
Hospital ethics
committee

29. REFERENCES
• Smeltzer CS, Bare GB, Hinkle LJ, Cheever HK. Brunner &
Suddarth’s textbook of Medical-surgical nursing. Volume I.
Twelfth edition. NewDelhi:Wolters Kluwer (India) ; 2011.
• Lewis LS, Dirksen RS, Heitkemper MM, Bucher L. Lewis’s
Medical Surgical NursingAssessment and management of
clinical problems. Second edition. Volume 1.India: Reed
Elsevier; 2015.
• Luggen SA. Core curriculum for gerentological nursing.
USA: Mosby publication; 1996.