1 bioethics workshop 15 june 2012 s.lo. outline: spectrum of quality of care 2 respectful care...
TRANSCRIPT
Outline:
Spectrum of Quality of care
2
Respectful care
Inadequate
careElder abuse
Respect Privacy & personhood
Bioethics Workshop 15 June 2012 S.Lo
Respectful Care
Respecting for autonomy
Respecting privacy and
personhood
Upholding dignity
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Respecting autonomy
Respect for individuality is a core
value in our society and is no less so when
caring for the elderly. In fact, it may be
even more needed because the elderly are
usually not as able as the younger
population to stand up for their rights and
their decisions. 4Bioethics Workshop 15 June 2012 S.Lo
Eldercare providers owe the elderly the duty to respect his autonomy and to enable them to exercise autonomy in a meaningful way.
Autonomy is also involved in the elder being able to give his “informed consent” to treatments – exercising autonomy depends upon relevant information and implies a capacity to use that information.
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Respecting autonomy (2)
Bioethics Workshop 15 June 2012 S.Lo
Where the elder’s mental capacity to understand his options and make decisions is in question, true autonomy may not exist.
Then, autonomy may be exercised through a surrogate, the moral or legal agent – substituted decision – should be made in the best possible interests of the elder involved.
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Respecting autonomy (3)
Bioethics Workshop 15 June 2012 S.Lo
Scenario 1:A 70-year-old female is diagnosed with
cancer, she refuses any invasive treatment.
As her care provider, what course of action you may find most appropriate
in her situation?
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Ethical considerations:Provided she has all her mental faculties and has been fully
informed of the benefits and consequences of various treatments, she may refuse any treatments and elect to have alternative therapies of acupuncture and natural remedies. In this case, she is utilizing her rights of autonomy.
However, the elder’s autonomy reigns only after her caregivers have discharged their duty to fully communicate the information needed, including the risks and benefits, in a manner that allows her to both form and render her informed consent or decision.
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Respect privacy and personhood Privacy and independence – both are the strongest
expression of personal identity.
Respecting privacy means not to invade or intrude upon an individual’s ‘personal space’ and not to pry.
Examples of such good aged care: Call a patient/client by name, Screen up for dressing , Respect client’s choice regarding their choice as to
when to get up from bed, when and what to eat, etc; and
Provide privacy during napkin change / toileting
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Upholding dignity
Disrespect and humiliation
Decreased dignity
Mutual respect and trust
Increased dignity
Bioethics Workshop 15 June 2012 S.Lo
Eight main factors that promote dignity in older people, all of which contribute to the person's sense of self respect.
1.Choice and control 2.Communication3.Pain management4.Personal hygiene5.Eating and nutritional care6.Practical assistance7.Privacy8.Social inclusion
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Magee, H., Parsons, S., & Askham, J. (2010)
Bioethics Workshop 15 June 2012 S.Lo
Inadequate careUnacceptable care provided to elderly people
Examples:Unchanged soiled bed sheetsLeaving trays of food without helping elder to eat
if (s)he is too frail to feed him/herselfUse excessive force to restrainIgnoring call for assistanceWashing or dressing client without regard to
his/her dignity
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Elder abuseFilial piety : do grown children owe
their parents? Ageism Risks factors Impacts of elder abuse on elders’
well-being Protect elders from abuse
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Definition of elder abuse [Or do we have one?]
WHO (2002): defining elder abuse as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm, mal-development or deprivation.”
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Filial piety – ‘xiao’Confucius’ emphasis on “xiao”, as adult
children’s taking respectful care for their aged parents, had a tremendous influence in shaping the Chinese understanding of the nature of morality.
Decline of such traditional values in Hong Kong (Chow, 2004)
Impacts from westernization, industrialization, and increase of nuclear families
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Ageism First used in 1960s to describe negative attitudes
towards older people and the way they are portrayed as a social problem and a burden on society simply because they are ‘old’.
Some common misconceptions and stereotype elders as:‘out of touch with reality’confusedfrailsenilevulnerablepowerless
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Risk factors of elder abuse
Social isolationPoor-quality long-term family
relationshipPattern of family violenceCarers’ personalityDependenceMental health problemsPoor run institution, under staff, poor
training
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Impacts on elders’ well-beingIncreased mortality (Lachs et al., 1998)
More likely to report poor health conditions (Fisher and Regan, 2006)
Experience significantly more psychological distress, anxiety and demonstrated socially inappropriate behaviour (Yan and Tang, 2001)
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Forces of social change impacting the traditional family structure in Hong Kong
Small public housing units – not encouraging multigenerational households, leaving elders alone
Elder’s expectation and care needs are not met
Challenges to the filial piety practices
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Elder abuse in HK’s cultural and social contexts
Protect elders from elder abuseVoices of older people
Culturally-sensitive interventions
Public awareness
General educationUphold traditional respectful attitudes
towards older people
Resources, policy-maker
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Scenario 2
Mr. & Mrs. Li are 87 and 89 years old
respectively. They are mentally
competent, albeit a bit unsteady on feet.
Their adult children hire a domestic helper
and instruct her not to allow the elder
parents out 24 hours a day.
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Ah Mo, 73-year-old, has diabetes and has becoming forgetful recently. To avoid her causing fire at home, her daughter send her to a Day Centre for Elderly People
every morning on her way to work. The daughter then picks her up after work.
After the Centre closes and before the daughter finishes work, Ah Mo needs to wait in a nearby park or to wander in a
nearby shopping mall.
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Scenario 3
Kwong, a son of a 76-year-old widow, who is physically
independent.
Kwong often has to work till 1-2 o’clock in the morning. When he
returns home, he sometimes wakes her mom up to make him
night meal.Bioethics Workshop 15 June 2012 S.Lo 25
Scenario 4