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Ethical _ Legal Issues in NICU - HKBIC Home Page

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Bioethics Workshop 15 June 2012 S.Lo
                          Outline:

Respectful     Respect                       Inadequate   Elder
               Privacy &                        care      abuse
  care
               personhood




             Spectrum of Quality of care

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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.


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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
                                                                            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. Choice and control
2. Communication
3. Pain management
4. Personal hygiene
5. Eating and nutritional care
6. Practical assistance
7. Privacy
8. 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




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Types of elder abuse (2)




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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

				
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