Ethical Issues in Aged Care: I. Information Disclosure II Ethical Issues in Aged Care: I. Information Disclosure II. Informed Consent Bioethics June 2012_S. Lo

Ethical Issues in Aged Care Information Disclosure Informed Consent http://www.census2011.gov.hk/flash/dashboards/population-growth-db-101-en/population-growth-db-101-en.html Bioethics June 2012_S. Lo

Hong Kong Population Pyramid 1961 2005 2033 Bioethics June 2012_S. Lo

Long life expectancy and Ageing population - Expectation of life at birth : 1983 2005 2033 Male 72.3  78.8  82.5 Female 78.4  84.4  88.0 - Ageing of the population Population of the elderly (65+) : 3.2% (1961)  12.1% (2005)  26.8% (2033) Bioethics June 2012_S. Lo

Outline: Information disclosure Informed Consent: Right to Information; Autonomy Veracity Informed Consent: Elder’s mental capacity Information to be given Freedom in decision-making Bioethics June 2012_S. Lo

Ethical Principles: The fundamental principle – respect an individual's autonomy Simple but important – do no harm! When you are certain that you are doing no harm, is there anything positive you can do! Principle serves as a check on personal consistency. Principle serves as a check on social consistency. Principle provides a mechanism for choosing between multiple GOODS. Principle helps to distinguish the intended GOOD from foreseeable BAD. Respect for Persons Non- maleficence Beneficence Integrity Justice Utility Double-effect These are the 3 KEY principles for ethical decision making These 2 provide checks on consistency Pragmatic principles that may help resolve specific difficulties. Beabout & Wennemann, Applied Professional Ethics

I know something is wrong with me, but what it is? A. Right to Information Fundamental Human Rights Moral doctrine of diagnosis disclosure is derived from: respect for the elder’s autonomy beneficence should truth-telling become a moral absolute? I know something is wrong with me, but what it is? Bioethics June 2012_S. Lo

Views of carers, patients and their peer When is it justified to withhold the truth from an elderly patient? Is it justifiable to deceive a patient with a cover-up story? What if the truth could be harmful? Bioethics June 2012_S. Lo

B. Veracity Professional obligation to tell the truth Virtue Fidelity (imposes obligations implicitly in a trusting relationship) Bioethics June 2012_S. Lo

C. Informed Consent/Refusal by Elders Mental Capacity Adequate Information Voluntariness

Mental Capacity: All adults are assumed to have capacity, unless they have an impairment affecting their mind (e.g. severe stage of dementia). The overriding principle is that the disclosure of confidential information is made in the best interests of the person lacking capacity. Bioethics June 2012_S. Lo

Adequate Information The diagnosis The treatment plan Risks of treatment Alternatives available Opportunity for clarification Bioethics June 2012_S. Lo

Voluntariness Elders should be able to make his/her own health care decision at a free will, not under any undue influence from the doctor, family, even the next-of-kin. Bioethics June 2012_S. Lo

Caring and treating elders who lack capacity: Paternalism - overriding a person’s known preferences based on the justification that this will benefit them or avoid harm to them - easier to justify carrying out life-saving surgery than routine procedures Hence, paternalism may be justified when applied in the elder’s best interests. Bioethics June 2012_S. Lo

Case 1 for discussion: Ah Tai, a 68-year-old woman visits her doctor with complaints of abdominal pain that is persistent but not extreme. Investigation reveals that she has metastatic cancer of the pancreas. The woman has just retired from a busy professional career, and she and her husband are about to leave on a round-the-world cruise that they have been planning for over a year. Would you tell her her diagnosis? How do you justify your ethical grounds? Bioethics June 2012_S. Lo

Case 2 for discussion: Chan Kueng, an 82-year-old man is admitted into hospital with a chief concern of weight loss, generalized weakness, and a pulmonary mass revealed in an x-ray. His family approaches the doctor and asks that the patient not be told, stating that in his upbringing in mainland China, tuberculosis (TB) was considered fatal and to tell him would be like giving him a “death sentence.” Should the family’s request be complied with? How do you justify your decision? Bioethics June 2012_S. Lo

Case 3 for discussion: Mr. Tam is 66 years old and has been brought into hospital with unstable angina. He is clearly worried about why he feels so poorly and what is going ‘to be done’ to him. An angiogram is considered the next useful investigation, but the doctor is concerned that if Mr. Tam is told about the risks he may become very anxious, thus precipitating a fatal myocardial infarction. To tell or not to tell? How to justify your option with ethical principles? Bioethics June 2012_S. Lo

Case 4 for discussion: Leung has schizophrenia and is convinced that worms are crawling over his skin. He finds this extremely distressing. One treatment that could be tried for him is a new antipsychotic drug, but this carries an 8% risk of permanent eye damage. Should Leung be informed of this risk? Why? Bioethics June 2012_S. Lo

References: Casas, A.V., (2008). Patients’ right to information: a review of the regulatory ethical framework. Retrieved on 9 June 2012 from http://www.ub.edu/bid/21/vall3.htm Hope, T., Savulescu, J. and Hendrick, J. (2003) Medical Ethics and Law: The core curriculum. Churchill Livingstone, Edinburgh. Pinner, G. (2000). Truth-telling and the diagnosis of dementia. British Journal of Psychiatry. 176, pp. 514-515 Pierce, J. & Randels, G. (2010). Contemporary Bioethics. New York: Oxford University Press. Bioethics June 2012_S. Lo