(OA) Ch 9: Legal and Ethical Concerns

autonomy

______________________ is the personal freedom to direct one's own life as long as it does not infringe on the rights of others.

(person is capable of rational thought and is able to recognize the need for problem solving.)

independence

loss of autonomy is equal to loss of ________________________.

competency

___________________ is a legal term that refers to the ability to fulfill one’s role and handle one’s affairs in a responsible manner.

-applies to all adults, unless declared otherwise.

-determined by court of law

guardianship

If the court determines that the person is incompetent (i.e., incapable of making decisions on his or her own behalf), the judge assigns either a partial or a full ______________ (also called a conservatorship).

-partial: person can make limited decisions
-full: person cannot make any decisions

-usually initiated as a last resort option

decision making capacity

_______________________ is a measure of a person’s ability to make an informed and logical decision about a particular aspect of his or her health care, a clinical term.

-determined by health care practitioners

-should not be based on chronologic age or a particular diagnosis.

-not "all or nothing"

Decisional

___________________ autonomy refers to the ability and freedom to make decisions without external influence.

executional

___________________ autonomy refers to the ability to implement the decisions.

advance directives

______________________ are legally binding documents that allow competent people to document what medical care they would or would not want to receive if they were not capable of making decisions and communicating their wishes.

-enable a person to appoint a health care proxy (responsible for communicating the person’s wishes if he or she becomes incompetent or unable to communicate them)

Patient Self-Determination Act (PSDA)

______________________________ became effective on December 1, 1991, provides the legal mandate for advance directives.

-requiring that providers:
--Inform patients of their right to refuse
--provide info on advance directives
--ask about advance directives
--include documentation of advance directives
--provide education to staff

durable power of attorney for health care

A ______________________________ is an advance directive that takes effect whenever someone cannot, for any reason, provide informed consent for health care treatment decisions.

-enables a surrogate health care decision maker (aka health proxy) to represent the person during any time of incapacity

-often considered the most important advance directive

-must be initiated when the person is competent, and it takes effect only when the person is incapacitated.

Do Not Resuscitate (DNR)

___________________________ is a very specific type of advance directive that compels health care providers to refrain from cardiopulmonary resuscitation if the person is no longer breathing and has no heartbeat.

-variations: "allow a natural death - And", "Comfort Care"

-DO NOT mistake this order as an order to withhold all medical treatment

living wills

____________________ are a type of advance directive whose purpose is to guide decisions about care that is provided or withheld under certain circumstances, usually at the end of life or when the person is considered terminally ill.

-major goal: affirm the right of a person to receive or refuse treatment (ex: antibiotics, food and nutrition, hospital admissions)

Physician Orders for Life-Sustaining Treatment (POLST... same thing as MOLST)

these medical directives are effective for ensuring that patient preferences are known and honored in all settings and situations, including emergencies and long-term care, do not replace advance directives

-Legally valid document serving as a medical order

Five Wishes

the organization Aging with Dignity promotes the use of the _______________ document for use as an advance directive.

-Who you want to make care decisions for you when you cannot make them?

-What kind of medical treatment you want or do not want?

-The level of comfort you want.

-How you want people to treat you.

-What you want your loved ones to know.

advanced care planning

_______________________ is defined as "a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care"

-Usually initiated by the person's primary care practitioner

-American Nurses Association Code of Ethics endorses nurses to promote this

Omnibus Budget Reconciliation Act (OBRA)

___________________ strengthened the government oversight of nursing homes and addressed the many issues related to quality of care.

-mandates Medicare-funded and Medicaid-funded to use Minimum Data Set (MDS) for assessment and care planning

-Nursing Home Residents’ Bill of Rights: residents should be aware of right and able to make complaints

Nursing Home Residents' Bill of Rights

_____________________________ is part of OBRA, residents should be aware of right and able to make complaints

-right to be fully informed

-to participate in care

-to make independent choices

-to privacy and confidentiality

-to dignity, respect, and freedom

-to security of possessions

-rights during admission + discharge

-to complain

-to visits

values clarification

________________________ is an ongoing process in which an individual becomes increasingly aware of what is important and just—and why

physical restraint

a ______________________ is defined as "any action or procedure that prevents a person's free body movement to a position of choice and/or normal access to his or her body by the use of any method, attached or adjacent to a person's body that he or she cannot control or remove easily"

-Ex: belts, hand mitts, soft wrist or leg restraints, certain types of chairs, and full side rails in certain circumstances.

-an ethical issue related to preservation of autonomy and dignity versus patient safety and protection.

Artificial Nutrition and Hydration (ANH)

_________________________ refers to methods of bypassing the upper gastrointestinal tract to deliver nutritional substances.

-ex: peg tubes

-ethical issue: used as a life sustaining measure, when pt is losing weight, or it takes very long to feed them.... does it actually prolong life? does it make patient uncomfortable?

-idea of comfort feeding only: patients should be fed only as long as it is comfortable for them to eat

Artificial Nutrition and Hydration (ANH)

Evidence-based info r/t _________________________:

-does not prolong life in those with dementia

-can be helpful in those with a reversible condition

-doesn't protect against aspiration

-associated with INCREASED risk of pressure ulcers

long

examples of ethical decisions that nurses in _______________-term care settings commonly address:

-safety vs freedom
-using restrictive devices
-prohibiting smoking
-allowing residents to refuse care
-care that is more convenient for staff but not for patients
-allowing sexual expression of residents

Anglocentric

legal requirements related to advance directives are strongly biased toward ___________________ cultures, with emphasis on individual autonomy.

language

__________________ barriers pose increase difficulty in understand advance directives

latin american, asian american

Cultural aspects of ethical issues: _________________________:

-Family-centered decision making approaches valued
-Filial piety (respect for authority of one's elders)

ethnoreligious (Jews, Muslims, Hindus)

Cultural aspects of ethical issues: _________________________ groups:

-End-of-life decisions based on the sanctity of life