1 Bioethics Workshop 15 June 2012 S.Lo. Outline: Spectrum of Quality of care 2 Respectful care...

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Bioethics Workshop 15 June 2012 S.Lo

Outline:

Spectrum of Quality of care

2

Respectful care

Inadequate

careElder abuse

Respect Privacy & personhood


Respectful Care

Respecting for autonomy

Respecting privacy and

personhood

Upholding dignity

3Bioethics Workshop 15 June 2012 S.Lo

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)


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)


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?


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.


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


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)


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


Elder abuseFilial piety : do grown children owe

their parents? Ageism Risks factors Impacts of elder abuse on elders’

well-being Protect elders from abuse


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.”


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


Types of elder abuse


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Types of elder abuse (2)


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


Risk factors of elder abuse

Social isolationPoor-quality long-term family

relationshipPattern of family violenceCarers’ personalityDependenceMental health problemsPoor run institution, under staff, poor

training


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)

Bioethics Workshop 15 June 2012 S.Lo 20

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


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


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.


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.


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

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1 Bioethics Workshop 15 June 2012 S.Lo. Outline: Spectrum of Quality of care 2 Respectful care...

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