Ethical Issues of Aging and Independence Miss Shurouq Qadose 25/4/2011

Mr. Larry is a 92-year-old healthy man. He lived in his own apartment and is completely independent in ADLs. On June 14, 2000, he left his apartment complex at 8:09 a.m. to go to the store. While backing out of his driveway, he failed to see a school bus passing on the intersecting street and his car struck it on the passenger side. One child was killed and six others were injured. Residents and city officials are outraged, with many questioning why Mr. Larry was still driving.

Chronically ill older adults may experience cognitive disorders, suffer from pain and discomfort, endure poor quality of life, or need to cope with end-of-life issues.

Issues surrounding the ethical care of older adults are complex and often require the integration of personal values and morals, as well as other factors specific to the nurse, the client, and the situation. Each person in the situation (client/resident, nurse, case manager, discharge planner, social worker, physician, family, and lawyer) has a personal perspective on effectively managing the situation based on their individual values, life experiences, education, and other factors.

The ethical practice of nurses and other health care professionals involves the application of ethical principles to each situation. Ethical principles provide a framework for understanding the ethical issues that frequently arise among the care of older adults. In bioethics, four principles guide ethical deliberations: autonomy, beneficence, nonmaleficence, and justice.

Autonomy Autonomy conveys a respect for the person’s ability to govern self or to freely choose one’s actions as long as these choices do not interfere with the autonomy or rights of other persons. This principle has also been called self-governance or self- determinism (Hogstel, 2001). World Reference.com defines self determinism as the determination of “one’s own fate or course of action without compulsion.” Decisions involving autonomy or self- determination must consider the patient’s right to choose for themselves, regardless of the consequences.

Issues surrounding autonomy or self-determination are seen frequently in clinical areas, when patients refuse medications, treatments, and surgical procedures that are likely to improve their health. For example, clients of particular cultural and religious backgrounds do not believe in blood transfusion and, thus, will not consent to this procedure, even though it may be necessary to save lives.

Ethical issues and dilemmas that surround this principle also include informed consent. Informed consent is defined by world dictionary. com as the “consent by a patient to a medical or surgical treatment or to participate in an experiment after the patient understands the risks involved.”

Informed consent is a required component of all health care procedures and research studies and shows respect for persons by supporting autonomous choice. From an ethical and caring perspective, informed consent decreases anxiety about health care interventions and encourages health care professionals, including nurses and researchers, to act responsibly during clinical practice and research.

Violations in informed consent have resulted in a great deal of mistrust of health care professionals and researchers from the perspective of older adults.

In order to implement this principle safely in health care institutions where research is conducted, institutional review boards (IRBs) are established. The role of IRBs is to protect clients from unethical behavior on the part of researchers and clinicians. In so doing, IRBS ensure that research participants provide informed consent prior to participation in research, that the participants’ results are confidential, and that no manipulation or coercion occurs.

Beneficence Beneficence is defined as “doing good or participating in behavior that benefits a recipient of care.” In ethical dilemmas, nurses and other health care professionals must weigh the ability and right to act autonomously with the good and the bad of each considered action and then render a decision based on which action would be the most beneficial to the client and, thus, meet the health care goals.

Nonmaleficence Nonmaleficence focuses on the health care provider’s mandate to “above all, do no harm.”

Nonmaleficence provides the legal and correctional framework. It places value on all human life and freedom, the importance of each person’s life and the need to honor the human dignity and choices of each person (Hogstel, 2001). Discussions of active and passive euthanasia involve the principle of nonmaleficence. Active euthanasia, committing a fatal act on an ill person, is not morally acceptable in most societies.

Passive euthanasia, letting a person die by omitting treatment (such as food, medication, or surgery to maintain life) and allowing the disease or injury to cause death.

The decision to omit treatment needed to sustain life involves the analysis of ethical principles and the use of excellent communication with all involved individuals, including the client, health care providers, and family.

Justice “ The principle of justice supports the fair allocation of resources to individuals or the provision of an equal share of available resources to each person” (Hogstel, 2001, p. 540). This principle has specific application to older adults who must consistently fight against ageism.

Ageism has the power to destroy the dignity and respect of older adults and impacts policies and care decisions for this population. Nurses must work consistently to identify ageism and mitigate its ability to influence policies and care decisions that will affect the quality of life of older adults. In so doing, nurses play an instrumental role in preventing the consequences of aging on older adults. This includes making sure that older adults are not discriminated against in selection for medical procedures or resources.

DRIVING

The risk for injuries, hospitalizations, and death from automobile accidents is increased in the older adult population because of the many normal and pathological changes in the neuromuscular and sensory systems.

It is estimated that the number of elderly traffic fatalities will more than triple by the year 2030, exceeding the number of alcohol-related fatalities in 1995 by 35% (Burkhardt et al., 1998). In addition, the increase in older drivers presents additional problems, because cars, roads, and highways were not developed to accommodate normal changes of aging among older drivers. This results in a large number of older adults unable to safely drive.

There are many ethical issues surrounding the decision about whether older adults should continue to drive. Back to the case study in the beginning Mr. Larry

One ageist solution that has been suggested is to revoke their license to drive at a certain age. In fact, this has been considered as a viable solution to the problem. However, this will result in a great loss of independence among this population, and considering the ethical principles stated earlier, it is important to discuss ways in which older adults may be assisted to maintain their safety and independence as long as possible, while still protecting the safety of other drivers, passengers.

Nurses can play an essential role in helping older adults to maintain safe driving practices and ensure the safety of the community by assessing normal and pathological changes of aging in the older adult. The implementation of strategies to reduce the effects of normal aging and manage disease are also important components of safe driving. In addition, nurses should recommend that patients learn to drive again, adapting to their neuromuscular and sensory changes.

Sexuality in Older Adults Read from the book page 229 Gambling 235

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