Ethics

Ethics

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You Let Them Do What??!! Decision-Making Capacity and the Exercise of Patient Autonomy in LTC

In long-term care (LTC), there is a dynamic balance between patient autonomy and rights and the duty to protect those under our care (facility-directed beneficence). LTC residents commonly exhibit conditions that negatively impact their ability to engage in a rational decision-making process. At the same time, patient rights statutes tend to assume that persons in our care are capable of making their own decisions, and are heavily weighted toward preserving patient autonomy.

10 Ethical Principles in Geriatrics and Long-Term Care

1. Beneficence
•Do right (“good”) by the patient.
•The physician’s main concern is the welfare of the patient.
•Do what is medically helpful.

2. Non-Maleficence
•Avoiding harm.
•Implement effective non-hospital treatment when possible (due to complications that can arise during hospitalization of elderly patients).
•Withhold diagnostic work-up or treatment when intervention is unlikely to result in meaningful survival or patient well-being.

3. Futility of Treatment
•Treatment should be consistent with the patient’s(clinically realistic) goals.

Rationing Healthcare or the Right to Die?

The ongoing debate on healthcare reform took an interesting turn over the past summer as focus shifted, at least for a short period of time, to the question of when to pull the plug on Grandma. The debate ended, at least for now, as politicians all ducked for cover claiming that government would never pull Grandma’s plug.

Of course, sooner or later, absent nature’s intervention, someone needs to pull the plug on Grandma. The question is who, when, and under what circumstances. Since this question first hit the courts, more than 30 years ago, our courts have consistently held that this

10 Ethical Principles in Geriatrics and Long-Term Care

1. Beneficence
• Do right (“good”) by the patient.
• The physician’s main concern is the welfare of the patient.
• Do what is medically helpful.

2. Non-Maleficence
• Avoiding harm.
• Implement effective non-hospital treatment when possible (due to complications that can arise during hospitalization of elderly patients).
• Withhold diagnostic work-up or treatment when intervention is unlikely to result in meaningful survival or patient well-being.

3. Futility of Treatment
• Treatment should be consistent with the patient’s(clinically r

10 Ethical Principles in Geriatrics and Long-Term Care

1. Beneficence
• Do right (“good”) by the patient.
• The physician’s main concern is the welfare of the patient.
• Do what is medically helpful.

2. Non-Maleficence
• Avoiding harm.
• Implement effective non-hospital treatment when possible (due to complications that can arise during hospitalization of elderly patients).
• Withhold diagnostic work-up or treatment when intervention is unlikely to result in meaningful survival or patient well-being.

3. Futility of Treatment
• Treatment should be consistent with the patient’s(clinically r

Medical Futility: Ethical, Legal, and Policy Issues

Introduction Physicians often encounter situations in which they believe a particular treatment that they are being asked to provide may not confer any meaningful benefit to their patient. In these cases, a practitioner may decide to withdraw this treatment because he or she has judged it to be futile. However, futility is a morally and ethically freighted term, and physicians need to be knowledgeable about its definition and implications before unilaterally deciding to withdraw treatment. The impact on the healthcare system of providing medically futile care is also uncert

The Power of Stories: Narrative Ethics in Long-Term Care

Introduction

Narrative ethics provides a framework for ethical decision making. This framework informs healthcare practitioners that to make an ethical decision regarding the life and well-being of an individual, one must view that individual’s stories, history, and character as a key component of the decision-making process. It should complement and enhance the usual approach to ethical decision making, which is often based on the foundational principles of autonomy, beneficence, non-maleficence, and justice.

In the clinical setting, narrative ethics is applied through understanding t

10 Ethical Principles in Geriatrics and Long-Term Care

1. Beneficence

•Do right (“good”) by the patient.
•The physician’s main concern is the welfare of the patient.
•Do what is medically helpful.

2. Non-Maleficence

•Avoiding harm.
•Implement effective non-hospital treatment when possible (due to complications that can arise during hospitalization of elderly patients).
•Withhold diagnostic work-up or treatment when intervention is unlikely to result in meaningful survival or patient well-being.

3. Futility of Treatment

•Treatment should be consistent with the patient’s(clinically realistic) goals.
•Asses

Medical Malpractice and Long-Term Care; Part II: Risk Management

This is part II of a two-part article. Part I addressed litigation and appeared in the April issue of the Journal.

Introduction
There has been a significant increase in medical malpractice lawsuits in long-term care (LTC).1 Therefore, the facilities and the healthcare providers who work in them need to be aware of several important risk management strategies that can reduce their likelihood of being sued for medical malpractice. Good medical practice and medical malpractice risk reduction are congruent activities.2 There are, however, several areas of practice where a li

10 Ethical Principles in Geriatrics and Long-Term Care

1. BENEFICENCE
• Do right (“good”) by the patient.
• The physician’s main concern is the welfare of the patient.
• Do what is medically helpful.

2. NON-MALEFICENCE
• Avoiding harm.
• Implement effective non-hospital treatment when possible (due to complications that can arise during hospitalization of elderly patients).
• Withhold diagnostic work-up or treatment when intervention is unlikely to result in meaningful survival or patient well-being.

3. FUTILITY OF TREATMENT
• Treatment should be consistent with the patient’s (clinically