ETHICO-LEGAL
CONSIDERATIONS IN THE
CARE OF THE OLDER
PERSONS
SHEILA MARIE OCONER, RN MAN
Ethical Principles
 Ethical values are essential for any
healthcare provider.
 Ethics comes from the Greek
word “ethos,” meaning character.
 Ethical values are universal rules
of conduct that provide a practical
basis for identifying what kinds of
actions, intentions, and motives
are valued
 Ethics are moral principles that
govern how the person or a group will
behave or conduct themselves. The
focus pertains to the right and wrong
of actions and encompasses the
decision-making process of
determining the ultimate
consequences of those actions.
 Each person has their own set of personal ethics
and morals
 Ethics within healthcare are important because
workers must recognize healthcare dilemmas,
make good judgments and decisions based on
their values while keeping within the laws that
govern them
 To practice competently with integrity, nurses,
like all healthcare professionals, must have
regulation and guidance within the profession.
 The American Nurses Association (ANA) has
developed the Code of Ethics for this purpose
Ethical dilemmas arise as nurses care for
patients.
These dilemmas may, at times, conflict with
the Code of Ethics or with the nurse's ethical
values.
 Nurses are advocates for patients and
must find a balance while delivering
patient care.
 There are four main principles of ethics:
autonomy, beneficence, justice, and nonmaleficence.
Each patient has the right to make their own
decisions based on their own beliefs and values. This
is known as autonomy.
A patient's need for autonomy may conflict with care
guidelines or suggestions that nurses or other
healthcare workers believe is best.
A person has a right to refuse medications, treatment,
surgery, or other medical interventions regardless of
what benefit may come from it. If a patient chooses
not to receive a treatment that could potentially
provide a benefit, the nurse must respect that choice.
Nurses have a responsibility to
themselves, their profession, and their
patients to maintain the highest ethical
principals
Long-term care
 involves a variety of services
designed to meet a person's health
or personal care needs during a
short or long period of time.
 These services help people live as
independently
and
safely
as
possible when they can no longer
perform everyday activities on their
own.
 Long-term care is provided in
different places by different
caregivers, depending on a
person's needs.
 Most long-term care is provided
at home by unpaid family
members and friends. It can also
be given in a facility such as a
nursing home or in the
community, for example, in an
adult day care center.
 Most elderly people prefer to
stay in their own home for as
long as possible.
https://www.nia.nih.gov/health/what-long-term-care
Assisted living in a long-term
services provide around-the-clock
nursing care in a homelike setting
Palliative care
 Relieves the side effects and symptoms
of an illness, but does not replace the
primary care for the illness. Its goal is to
make the person comfortable and
improve the quality of life.
 Is the treatment for the physical,
emotional and psychological symptoms
that can occur during a serious illness. In
modern palliative care, doctors and care
givers focus, not on curing or extending
life, but on optimizing everyday life.
Palliative Care vs. Hospice
Hospice care patients
have a terminal illness
that they are no longer receiving curative treatment for.
They typically only have months to live.
Palliative care is a part of hospice treatment and it’s
appropriate at any point during a serious illness.
Benefits of Palliative Care
•Improves communication between the patient and
health care providers
•Opens discussions about treatment options and
symptom management so the patient is more involved
•Relieves pain and discomfort from symptoms such as
nausea and shortness of breath
•Improves coordination of care with health care
providers, the patient and family.
•Meets the emotional needs of the patient
•Provides for the spiritual needs of the patient
https://www.seniorliving.org/palliative-care/
Advance directives
 Are legal documents that allow the person to lay down their
decisions about end-of-life care ahead of time. They may give
or tell their wishes to family, friends, and health care
professionals and to avoid confusion later on.
 A living will tells which treatments a person wants if dying or
permanently unconscious state comes. A person can accept
or refuse medical care. The person might want to include
instructions on
•The use of dialysis and breathing machines
•If you want to be resuscitated if your breathing or heartbeat
stops
•Tube feeding
•Organ or tissue donation
 A durable power of attorney for health care is a document that
names a health care proxy. The proxy is someone the
person can trust to make health decisions if unable to do so.
https://medlineplus.gov/advancedirectives.html
Do not resuscitate (DNR) order
Resuscitation means medical staff will try to re-start the
heart and breathing using methods such as CPR
(cardiopulmonary resuscitation) and AED (automated
external defibrillator). In some cases, they may also use
life-sustaining devices such as breathing machines
In the hospital
A Do Not Resuscitate or DNR order means that if the
person stop breathing or the heart stops, nothing will be
done to try to keep the person alive.
The Doctor can be ask to add a DNR order to the medical
record not wanting a hospital staff to try to revive the
heart or breathing stopped.
Some hospitals require a new DNR order each time the
person is admitted, and might need to ask every time
they go into the hospital. But remember that this DNR
order is only good while the person is in the hospital.
https://www.cancer.org/treatment/finding-and-paying-fortreatment/understanding-financial-and-legal-matters/advancedirectives/types-of-advance-health-care-directives.html
END OF LIFE CARE
 Comfort care is an essential part of medical care at
the end of life. It is care that helps or soothes a person
who is dying. The goals are to prevent or relieve suffering
as much as possible and to improve quality of life while
respecting the dying person's wishes.
 People who are dying need care in four areas—physical
comfort, mental and emotional needs, spiritual issues,
and practical tasks. Their families need support as well.
 Death comes suddenly, or a person lingers, gradually
fading. For some older people, the body weakens while
the mind stays alert. Others remain physically strong, but
cognitive losses take a huge toll. Although everyone dies,
each loss is personally felt by those close to the one who
has died.
 End-of-life care is the term used to describe
the support and medical care given during the
time surrounding death. Such care does not
happen only in the moments before breathing
ceases and the heart stops beating. Older
people often live with one or more chronic
illnesses and need a lot of care for days,
weeks, and even months before death.
End-of-Life: Providing Physical
Comfort
There are ways to make a person who is dying more
comfortable. Discomfort can come from a variety of
problems. For each, there are things you or a healthcare
provider can do, depending on the cause. For example,
a dying person can be uncomfortable because of:
Pain
Breathing problems
Skin irritation
Digestive problems
Temperature sensitivity
Fatigue
End-of-Life: Managing Mental and
Emotional Needs
 Complete end-of-life care also includes
helping the dying person manage mental
and emotional distress. Someone who is
alert near the end of life might
understandably feel depressed or anxious.
It is important to treat emotional pain and
suffering.
 The simple act of physical contact—holding
hands, a touch, or a gentle massage—can
make a person feel connected to those he
or she loves.
 Some experts suggest that when death is very
near, music at a low volume and soft lighting are
soothing. In fact, near the end of life, music
therapy might improve mood, help with relaxation,
and lessen pain.
 People nearing the end of life may have spiritual
needs as important as their physical concerns.
Spiritual needs include finding meaning in one's
life and ending disagreements with others, if
possible. The dying person might find peace by
resolving unsettled issues with friends or family.
https://www.nia.nih.gov/health/providing-comfort-end-life
Canon Law - Anointing of the Sick
 Sacrosanctum concilium 59 and Canon 840 of the 1983
Code of Canon Law note that sacraments are ordered for
the sanctification of all people and to build up the Body of
Christ in order that they may render worship to God.
 Known as the Pastoral Care of the Sick: Rites of Anointing
and Viaticum. It also includes sections pertaining to the
care of the sick, pastoral care of the dying and readings,
responses and verses from Scripture.
WHO MAY BE ANOINTED?
Baptized members of the Christian faithful who
have reached the age of reason and who begin
to be in danger due to sickness or old age may
receive the sacrament of anointing.
Participation in the rites is encouraged broadly.
For example:
•The elderly who are weakened, even though no
notable illness is present, may choose to
participate in the ritual.5
•Those who face surgery due to serious illness
•Those who suffer serious mental illness
https://www.chausa.org/publications/health-progress/article/september-october-2011/canon-law---anointing-of-the-sick-thehow-and-why