Legal and Ethical concerns

Key issues for the Elderly

  1. Autonomy and Rights

  2. Advance Directives

  3. Legal issues Specific to long term care

  4. Ethical issues in Gerontological Nursing

  5. Medical Assistance in Dying (MAiD)

Autonomy and Right

Competency: legal term that refers to the ability to fulfills one’s role and handle one’s affairs in a responsible manner (competent)

Decision making capacity: A measure of a person’s ability to make an informed and logical decision about a particular aspect of his or her own health care

Guardianship:

Partial Guardianship: incompetent person continues to make limited decision

Full Guardianship: the person loses all his/her rights to make decisions

Trusteeship: applies when an older adult no longer has the capacity to make a decision on financial matters

Advance directives:

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/ or communicating their wishes

ex) MOST or living will

Legal issues specific to LTC settings

  • nursing home resident’s rights in Canada are primarily legislated at the provincial / territorial

  • Ethical issues are associated with questions about safety versus freedom of the residents

Ethical Issues in Gerontological Nursing

  • Use of Restraints

    • physical restraint: devices, methods, or equipment that immobilizes or reduces the ability of patient to move his or her arms, legs, body or head freely

    • Restraints are not seen as patient safety and protection devices, limits autonomy and dignity

    • associated with serious harm, increased risk for delirium, fractures, soft tissue injury and death

  • Artificial Nutrition and Hydration

    Bypassing the upper Gastrointestinal system to deliver nutritional substances

    • PEG tube

    • Jejunostomy tube

    • NG tube

    • TPN central intravenous catheter

    • Hypodermoclysis

    Issues with quality of life, some people genuinely enjoys food

MAiD (Medical Assistance in dying) Criteria:

  • Person is eligible for MAID if they meet ALL of the criteria

  • A person has grievous and irremediable medical condition only if all the criteria is met

Nursing roles in MAiD ( 3 roles)

  • determine eligibility

  • providing MAiD

  • aiding in provision of MAiD

Cannot prescribe, compound, dispense, administer any substance intended for the purpose of MAiD

Elder abuse and Neglect

Senior abuse: Generic term referring to a wide variety of harms to older adults that are committed by a person or persons they know and would normally have a reason to trust

Risk factors for Elder abuse and Neglect:

Perpetrator risk factors for elder abuse :

  • mental illness

  • alcoholism

  • hostility

  • financial dependency on the victim

Victim risk factors for elder abuse

  • cognitive impairment

  • problem behaviours

  • disability

  • physical dependency

  • financial dependency

  • shared living arrangements

  • isolation or lack of social supports

Types of abuse

  • physical

  • sexual

  • emotional/ psychological

  • exploitation

  • neglect

  • abandonment

  • self-neglect

Physical Abuse

inflicting, or threatening to inflict, physical pain or injury on a vulnerable elder or depriving him or her of a basic need

Sexual Abuse

Nonconsensual sexual contact of any kind, coercing an elder to witness sexual behaviours

Emotional abuse

Spiritual abuse

The denial of a residents right to spiritual practices

Financial Exploitation

illegal, misuse, or concealment of funds, property assets of a vulnerable elder

Neglect

Refusal or failure by those responsible to provide food, shelter, health care or protection for a vulnerable elder