This document discusses several ethical issues related to caring for the elderly and chronically ill, including:
1. Advance care planning which allows patients to identify healthcare preferences and surrogate decision makers in case they lose decision-making capacity.
2. Determining decision-making capacity and identifying appropriate surrogate decision makers.
3. Guidelines for withdrawing or withholding life-sustaining treatment based on patient values and medical necessity.
4. Principles of justice in allocating healthcare resources and avoiding age discrimination.
5. Recommending nursing home placement based primarily on patient safety needs.
This document discusses several ethical issues related to caring for the elderly and chronically ill, including:
1. Advance care planning which allows patients to identify healthcare preferences and surrogate decision makers in case they lose decision-making capacity.
2. Determining decision-making capacity and identifying appropriate surrogate decision makers.
3. Guidelines for withdrawing or withholding life-sustaining treatment based on patient values and medical necessity.
4. Principles of justice in allocating healthcare resources and avoiding age discrimination.
5. Recommending nursing home placement based primarily on patient safety needs.
This document discusses several ethical issues related to caring for the elderly and chronically ill, including:
1. Advance care planning which allows patients to identify healthcare preferences and surrogate decision makers in case they lose decision-making capacity.
2. Determining decision-making capacity and identifying appropriate surrogate decision makers.
3. Guidelines for withdrawing or withholding life-sustaining treatment based on patient values and medical necessity.
4. Principles of justice in allocating healthcare resources and avoiding age discrimination.
5. Recommending nursing home placement based primarily on patient safety needs.
This document discusses several ethical issues related to caring for the elderly and chronically ill, including:
1. Advance care planning which allows patients to identify healthcare preferences and surrogate decision makers in case they lose decision-making capacity.
2. Determining decision-making capacity and identifying appropriate surrogate decision makers.
3. Guidelines for withdrawing or withholding life-sustaining treatment based on patient values and medical necessity.
4. Principles of justice in allocating healthcare resources and avoiding age discrimination.
5. Recommending nursing home placement based primarily on patient safety needs.
Ethical Issues in Organ Transplant Allocation of Resources Ethical Principles Principles Involved Ethical Issues: Selection Of Recipient Entry to Transplantation Program General Guidelines Ethics of Organ Selling/Buying Virtues of A Catholic Health Care Giver
Ethical Principles 2 Forms of Advance Directives:
• Autonomy 1. Living will - The right to self-determination - based theoretically in the right that all competent • Informed Consent person have the right to refuse treatment or extra- - Legal doctrine requiring full disclosure ordinary measures • Beneficence - try to provide a mechanism for determining the • Non-maleficence wishes of an incompetent patients and carrying • Justice them out - Equal allocation of treatment to all - list of interventions and other actions that should Competency or should not be taken in specific circumstances - try to put the responsibility where it is perceived • Essentially the ability to make a decision to belong – on the patient – by ensuring that the • Patient is competent: person’s wishes will be respected even when 1. he has an understanding of the situation & the he/she cannot speak directly to this particular consequences of decision situation 2. the decision is based on rational reasons 2. Durable power of attorney for health Guide questions for determining competency of Patients - identifies surrogate decision maker in the even who refuse medical treatment: the patient lacks decision making capacity 1. Does the patient understand his medical condition? - legal document, authorized by the state 2. Does the patient understand the options and - Voluntarily delegating or directing future medical consequences of his decision? decision-making power 3. Does the patient refuse medical treatment based on - A competent individual (principal) directs, through rational reasons? the appointment of an agent (attorney in fact, 4. If the patient refuses treatment based on religious need not be an attorney at law), the making of beliefs , are religious beliefs held by a sufficient medical decisions in the event of future incapacity number of persons for a sufficient period of time? Decision-making capacity Surrogate Decision Maker • Necessary in order to be autonomous and participate - One who best understands the patient’s health care in informed consent values and goals • Ability to communicate a choice - Usually family members • Manipulate rationally the information necessary to - Court-appointed guardian, spouse, next of kin make the choice - Surrogate decision makers should base their • Reason consistently with previously expressed decision on the patient’s previously expressed values and goals values and goals • If a patient in incapable of decision making, the Withdrawing & Withholding Life-Sustaining Interventions clinician should identify an appropriate surrogate • Justifiable if: decision maker ✓ If the patients who requested have adequate Advance Care Planning decision making capacity • Allows patients to identify health care preferences ✓ If it no longer offers benefit to the patient and surrogate decision makers in the event the ✓ Withdrawing and withholding life-sustaining patient cannot make health care decisions interventions is NOT the same as Euthanasia • Patient-clinician discussion of future and end- of-life care and the completion of an advance directive Allocating Health Care Resources • Rationing occurs when a clinician withholds a Advanced Directives medically beneficial intervention because of its cost - creates a mechanism for capable adults to anticipate to someone other than the patient future scenarios and instruct their physicians • The ethical principle of justice refers to the duty to prospectively regarding the use of life-sustaining treat individuals fairly medical treatment • Injustice occurs when health care decisions are - promotes autonomy of patients who once possessed based on irrelevant patient-specific factors such as but now lacks decision making capacity age rather than on the medical need Recommending to Nursing Home Pension System: • Assisted living Social Security System • Consider if: - Renders services to private and self-employed – Physically disabled retirees – Cognitively impaired – Elderly - Must be at least 60 years old and paid 120 monthly – Poor contributions to avail retirement benefit – Loss of Social Support - Contributions can be paid either monthly or by lump • Primary reason for recommending patients to Nursing sum Homes should be safety - Lowest monthly pension: • What to look for in a Nursing Home: • Php 1200 if member has 120 monthly contribution – Meets the level of care needed • Php 2400 if member has at least 20 credited years – Geriatric Experience of service – Regular Medical Checkups Government Service Insurance System – Facility Design - Mainly for public sector workers – Medical Emergency Procedures - The Government Service Insurance Act of 1997 • Elderly, poor, physically-disabled, and cognitively • Increase monthly pension from Php 2700 to Php impaired, loss of social support 9000 • Safety is of the reason for offering nursing home care - Conditions for Retirement Benefit: • Autonomy vs Safety • At least 60 y/o • Must regard the benefits of nursing home care as • At least 15 years of service greater than the harms • Not receiving a monthly pension benefit from • Allows patients to identify health care preferences permanent total disability Philippine Veterans Affairs Office Laws protecting the rights of Elderly - Benefit programs for veterans 1986 Constitution - Mainly composed of veterans from World War II Article II, Section 9: “The state shall promote a just and dynamic social order that will ensure the prosperity Welfare Services and independence of the nation and free the people - Undertaken mainly through the Department of from poverty through policies that provide adequate Social Welfare and Development social services, promote full employment, a rising - Elderly Group is one of the 13 categories under standard of living, and an improved quality of life for “Disabled Persons”, under subheading “Socially all” Disabled” Article XIII, Section 11: “The state shall adopt an - Programs and service planned for the elderly integrated and comprehensive approach to health based on the following principles: development which shall endeavor to make essential • Right to have access to services and opportunities goods, health and social services available to all that will help him achieve a productive, people at affordable cost. There shall be priority for wholesome and satisfying life the needs of the unprivileged, sick, elderly, elderly • Family & community responsibility in recognizing disabled, women, and children. The State shall the potentials of elderly persons and the need to endeavor to provide free medical care to paupers”. provide opportunities to make minimum use of Article XV, Section 4: “The family has the duty to care such potentials for its elderly members although the State may also • Government’s responsibility to provide basic and do so through just programs of although the State essential services for the elderly may also do so through just programs of social • Care for the Elderly security”. – Homes for the Aged Article XVI of Section 8: “The State shall from time to – Senior Citizens Center time, review and upgrade the pensions and other – Discounts and Privileges benefits due to retirees of both the government and – Medical Dental Care private sector.” • Elderly Volunteer Program Expanded Senior Citizens Act of 2010 – Resource Volunteer Service - Republic Act No. 9994 – Foster Grandparents Services - An act granting additional benefits and privileges to – Peer Support Group senior citizens, further amending RA 7432, as – Peer Outreach/Respite Services amended, otherwise known as "an act to maximize – Family Enrichment Services the contribution of senior citizens to nation building, grant benefits and special privileges and for other – Neighborhood Watch purposes“ – Sponsorship Program Sec 4 • Training of Elderly – 20% discount and exemption from VAT – Livelihood Development Service – 5% to the monthly utilization of water and electricity Elderly Abuse - Section 4: Privileges for the Senior Citizens 4 categories: • Educational assistance • Physical Abuse • Special discounts on purchase of basic - acts committed with intention of causing physical commodities pain and injury • Express lanes • Psychological/Emotional Abuse - Section 5: Government assistance - involves verbal assaults, threats, humiliation and • Employment ridicule • Education • Material or Financial Exploitation • Health - misuse of property or money, theft, or forced • Social services signing of legal documents • Housing • Neglect • Access to public transport - Passive or Unintentional Neglect: Isolation of the elderly Expanded Senior Citizens Act of 2010 (RA 9994) - Active/ Intentional Neglect: Deliberate withholding - an act granting additional benefits and privileges to of items needed for daily living senior citizens, further amending RA 7432 of 1992 as amended by RA 9257 of 2003 Leisure Activities - aims to give flesh to the “social justice clause” - Vital in the daily life of the elderly - Article 7: Grant of 20% discount & VAT exemption - Two most frequent forms of recreation: • Section 1: Medical-related privileges • Radio Listening & TV Watching • Section 2: Domestic transportation privileges - Chatting withers serves as major mode of satisfying of • Section 3: Hotel and restaurant privileges social needs of the elderly • Section 4: Recreation centers - Attending religious gatherings and activities is another • Section 5: Admission fess privilege significant past time for the elderly in the Philippines • Section 6: Funeral and burial services
Current Legislation for the Elderly
Senior Citizens Act (RA 7432) - an act to maximize the contribution of senior citizens to nation building, grant benefits and special privileges, and for other purposes - approved on April 23, 1992 - Section 2: Definition of Terms • Senior citizen: any resident of the Philippines at least 60 years old, retired, and has an income of not more than sixty thousand pesos per annum - Section 4: Privileges for the Senior Citizens • Grant of 20% discount • Exemption from payment of income taxes and training fees for socioeconomic programs • Free medical and dental services in government establishments - Section 5: Government assistance - Section 6: Retirement benefits Senior Citizens Center Act of the Philippines (RA 7876) - an act establishing a senior citizens center in all cities and municipalities of the Philippines and appropriating funds - Section 5: Functions of the Centers • Identify needs, trainings, and opportunities • Initiate, develop, and implement productive activities and work schemes • Promote and maintain linkages for the delivery of health care
Expanded Senior Citizens Act of 2003 (RA 9257)
- an act granting additional benefits and privileges to senior citizens amending for the purpose RA 7432 - Approved: February 26, 2004