There are certain situations in which there is no proof of a medical benefit for PEG placement. No sleep, no eat, no move. For some elderly Geriatric etics difficult decisions patients, stoicism and fatalism can create barriers to effective pain management Carteret, ; Dhingra, Key questions need to be asked, including: The palliative and hospice focus of comfort care with peaceful and family support aspects may be more acceptable and in line with Buddhist beliefs and values.
The courts have repeatedly upheld the principle that competent patients may refuse or withdraw any medical treatment, even if that treatment is necessary to sustain life. There are two different ways to access the cases in Making Difficult Decisions with Patients and Families: Accidental or deliberate removal of the tube by the patient is another common complication.
Together, these clinical activities are the Achilles Heel for behavioral health providers. A Hawaiian woman with stomach cancer was experiencing abdominal pain but did not inform the family about her increasing pain because she did not want to be to a burden.
The clinician imparts knowledge to the patient and family, clarifying any misconceptions and presenting alternative interventions that can realistically achieve patient-specific goals of care, along with known possible harms and benefits of each. The discussion should be done in private. What do they know?
These organizations stress the importance of truly informed consent to allow patient autonomy to be possible. Decisions for such involved caregiving can be entered into only with serious and personal deliberation and prayer.
Doctors should be able to discuss the relevant ethical, moral and medical issues with family and patients openly and plainly.
For family members as caregivers, ethics is about doing what is right even when no one is looking.
S, how bad is your pain? Ideally, the conditions under which the PEG might be withdrawn in the future should be discussed and agreed upon prior to PEG placement. But nursing home care will separate the elder from their warm and familiar environment and will impose a more rigid schedule on the elder.
When the family is the decision-maker on health care issues, this may include the discussion and decision around an advance directive.
Absent an understanding of Medicare and Medicaid home health programs, as well as other caregiver resources available in the community, the planning by the eldercare and family team is likely to focus primarily, if not solely, on nursing home care.
Some studies even suggest increased mortality results when compared with conservative management. For professionals providing eldercare, ethics is about adherence to established canons of ethics promulgated by organizations such as the American Medical Association for physicians, the American Nurses Association  and National Association of Social Workers.
Garcia What went wrong? The worst thing you can do is act in haste.
Or is it because of the emotionally laden content of any discussion of withholding nutrition or hydration, albeit artificial, from patients? An initial assessment should include determining how well the patient and family speak and understand English and if there Geriatric etics difficult decisions a need for a certified medical interpreter.
Aside from the potential for clinical embarrassment if we make errors in the write-up of an assessment interview or an error in the diagnosis esmost clinicians do not give much thought to the potential for legal, ethical or other professional repercussions which might result from these routine activities.
The four principles plus scope approach claims that whatever our personal philosophy, politics, religion, moral theory, or life stance, we will find no difficulty in committing ourselves to four prima facie moral principles plus a reflective concern about their scope of application.
What does your pain mean to your body? Long trips and vacations are rare, and they need thorough, long-range planning in order to be accomplished.The Pennsylvania Geriatrics Society – Western Division is dedicated to improving the health and well-being of all older persons.
It is a non-profit organization of physicians and other health care professionals committed to the provision of quality health care for older persons.
CHAPTER 5 THE ETHICAL DEBATE page 77 The ethics of assisted suicide and euthanasia are squarely before the public eye. A steady drumbeat of media attention and mounting concern about control at life's end have generated serious consideration of legalizing the practices.
It would therefore be more difficult to (22) The Vatican's 30 Laurence McCullough, Nancy Wilson, Jill Rhymes, and Thomas Teasdale, “Managing the Conceptual and Ethical Dimensions of Long-Term Care Decision Making: A Preventive Ethics Approach,” in Long Term Care Decisions, Apr 06, · How can a group achieve the results it wants?
Justine Metz explains her guide for decision making and why we need it now more than ever. Justine Metz. Background. Hospitalized older adults frequently have impaired cognition and must rely on surrogates to make major medical decisions.
Ethical standards for surrogate decision making are well delineated, but little is known about what factors surrogates actually consider when making decisions. The Pennsylvania Geriatrics Society – Western Division is dedicated to improving the health and well-being of all older persons.
It is a non-profit organization of physicians and other health care professionals committed to the provision of quality health care for older persons.Download