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Bioethics Workshop 15 June 2012 S.Lo
Outline:
Respectful
care
Respect
Privacy &
personhood
Inadequate
care
Elder
abuse
Spectrum of Quality of care
Bioethics Workshop 15 June 2012 S.Lo
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Respectful Care
 Respecting for autonomy
 Respecting privacy and personhood
 Upholding dignity
Bioethics Workshop 15 June 2012 S.Lo
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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.
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Respecting autonomy (2)
 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 (3)
 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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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
Increased
dignity
Mutual respect
and trust
Disrespect and
humiliation
Bioethics Workshop 15 June 2012 S.Lo
Decreased
dignity
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Eight main factors that promote dignity in older
people, all of which contribute to the person's
sense of self respect.
1.
2.
3.
4.
5.
6.
7.
8.
Choice and control
Communication
Pain management
Personal hygiene
Eating and nutritional care
Practical assistance
Privacy
Social inclusion
Magee, H., Parsons, S., & Askham, J. (2010)
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Inadequate care
 Unacceptable care provided to elderly people
 Examples:
 Unchanged soiled bed sheets
 Leaving trays of food without helping elder to eat if (s)he is
too frail to feed him/herself
 Use excessive force to restrain
 Ignoring call for assistance
 Washing or dressing client without regard to his/her dignity
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Elder abuse
 Filial 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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Types of elder abuse
Physical
• Use of physical force that results in injury, pain
and impairment [slapping, punching, kicking]
Emotional
• Infliction of distress, anguish, and/or pain
through verbal or nonverbal acts.
Sexual
• Nonconsensual contact of any form.
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Types of elder abuse (2)
Neglect
• Refusal or failure to provide goods or services to the elder
• e.g. denying food or medical-related services
• Illegal or improper use of the elder’s resources, property,
funds…
Financial
• Desertion of an elder by the primary caretaker of the
elderly person
Abandonment
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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’
 confused
 frail
 senile
 vulnerable
 powerless
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Risk factors of elder abuse
 Social isolation
 Poor-quality long-term family relationship
 Pattern of family violence
 Carers’ personality
 Dependence
 Mental health problems
 Poor run institution, under staff, poor training
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Impacts on elders’ well-being
 Increased 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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Elder abuse in HK’s cultural and social contexts
 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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Protect elders from elder abuse
 Voices of older people
 Culturally-sensitive interventions
 Public awareness
 General education
 Uphold 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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Scenario 3
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 4
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.
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Bioethics Workshop 15 June 2012 S.Lo