1. ANGELA G. ROTHROCK, PHD ASSISTANT PROFESSOR DIVISION OF GERONTOLOGY, GERIATRICS, AND PALLIATIVE CARE NOVEMBER 6, 2015 Ethics and Aging

2. Plan for the Day Who are we? What is ethics? Theories and approaches Being an ethical professional Working ethically with patients/clients

3. Who are we? Who are the members of this group? How are we valued? What determines our worth? Are our decisions ethical? Moral?

4. What is Ethics? Wikipedia -- Ethics (also known as moral philosophy) is a branch of philosophy that addresses questions about morality—that is, concepts such as good vs. bad, noble vs. ignoble, right vs. wrong, and matters of justice, love, peace, and virtue. A studying and reflecting on morality, often in a systematic way……so then, what is morality?

5. What is Morality? Often first think about what we were told “to do” or “not to do” as a child  What are some “morals” we learned as children?  What have been 3 important influences on your understanding of right and wrong Concerned with relationships between people and how, ultimately, they can best live in peace and harmony Goal is to protect a high quality of life  For who? Individuals, groups, both?

6. So What is Morality? It is made up of a lot of values and duties, and character traits based on beliefs that people take for granted most of the time  Values –objects or things a person holds dear  Duties – actions in response to claims on you that are either self- imposed or imposed by others.  Virtue – traits and dispositions or attitudes All contribute to moral development So who do you admire for being a good moral person? Why? What are the traits that make them so?

7. Three Subgroups of Morality Personal Morality  The virtues, values, and duties that YOU have adopted as relevant. May be customs, laws, rules, beliefs  What are some examples? How will this impact your practice? Societal Morality  Like above, but generated by culture, ethnic groups, or geography.  Almost always consider deeper religious and philosophic beliefs about humans Group Morality  Often subscribed to by virtue of being a member of a religious group, club, an organization, profession, or other affiliation  Evident in policies, customs, and practices  Hippocratic Oath – one example of a mandatory code of ethics

8. Ethics Issues vs. Problems  An ethical “issue” is any situation you believe may have important moral challenges embedded in it that need to be identified  An ethical “problem” is a situation that you have reason to believe has serious negative implications regarding moral values and duties – and that will pose extremely difficult choices for individuals who want to help support high moral standards. “That’s the moral and ethical thing to do” What about your own conscience?

9. Questions 1 – imagine a situation that may arise in your professional career that would pose a challenge to your personal morality. What is it about the situation that creates the challenge. 2 – using the code of ethics from your own profession, what are 3 or 4 basic moral guidelines that you will be expected to follow?

10. The Caring Response Fundamentals include:  Elements of human nurturance – often like how you would treat your family or friends  Responsibilities entail clinical, ethical, and legal dimensions  The patient as a primary focus of loyalty  Limits guided by the patient’s vulnerability because of the health-related concern  Recognition of it as a professional responsibility involving duty  The condition that it be individualized

11. Components of Ethical Problems A – the moral agent  A person who acts for him/her self, or in the place of another by the authority of that person, and does so by conforming to a standard of right [or wrong] behavior C – the course of action  Includes the agent’s analysis, judgment process about the resolution to the moral challenge, and decision O – the desired outcome  The intended and hoped for result(s) of having taken a particular course of action

12. Reflection Describe an ethical dilemma that you or someone you know has faced.  What did you have to take into consideration as you moved toward a decision about which of the two or more courses of action available to you should be taken?  What were the results?

13. Ethical Principles Nonmaleficence and Beneficence  Professionals ethics limits include “do no harm”, “prevent harm”, and “remove harm when it is being inflicted”. Does NOT include “bring about positive good” Autonomy  the capacity to act on your own decisions freely and independently  The model of medical decision making for the past 30+ years  Implications include informed consent, disclosure of diagnoses, involvement of patients in end-of-life decisions, and advanced directives

14. Ethical Principles Fidelity  Being faithful to the patient – meeting the patient’s reasonable expectations Veracity  Binds you to honesty. You will tell the truth. Justice  An arbiter. Called upon when there are problems regarding what is rightfully due a person, institution, or society. Fair equitable, and appropriate distribution in society

15. Six-Step Process for Ethical Decision Making Ethical decision require your thoughtful reflection and logical judgment – even though the situation usually presents itself via partial facts and strong reactions The 6 Steps allow you to take the situation apart and look at it in an organized way, while still respecting the strong emotions attached.

16. Six-Step Process for Ethical Decision Making Step 1: Get the Story Straight  Gather relevant information Step 2: Identify the Type of Ethical Problem Step 3: Use Ethics Theories or Approaches for Analysis Step 4: Explore the Practical Alternatives Step 5: Complete the Action Step 6: Evaluate the Process and Outcome

17. Reflection 1 - The first step to ethical decision making is to gather as much information as possible. What types of guidelines would you use to decide that you have as much info as you need or can obtain? 2 – a necessary step is to act on your own conclusions about what ought to be done. Under what conditions, if any, would you decide NOT to act according to your own best moral insights and judgments? That is, what, if any, are limits to your willingness to act ethically?

18. Being an Ethical Professional HIPAA  Health Insurance Portability and Accountability Act http://www.youtube.com/watch?v=6wRDorQ73Ng&feature=related Informed consent  http://www.youtube.com/watch?v=h16Ujzw9VtA http://www.youtube.com/watch?v=h16Ujzw9VtA  Special issues for older adults Ethics committees

19. Working Ethically with Patients and Clients Special situations to consider:  Medical/Advance directives  Assessing patient wishes when can’t speak for self (Cruzan, 1990) – a constitutional basis for competent patients to direct their future medical treatment through the execution of advance directives  PSDA 1990 – Federal law requires states to educate patients entering institutions regarding advance directives  Types: Living wills, durable power of attorney for healthcare, DNR. Verbal statements to primary care physician or family is also acceptable, but tenuous (sample online)

20. Working Ethically with Patients and Clients Special situations to consider:  Problems with Medical/Advance directives  Vague terminology such as “heroic” or “extraordinary”  Difficult to anticipate the future  Change of mind  Portability  Is this the right thing to require ethically?  Are they even used? If so, do they improve care or save money?

21. Working Ethically with Patients and Clients Special situations to consider:  Driving – when/if to take away the keys?  http://www.cbsnews.com/video/watch/?id=5205371n http://www.cbsnews.com/video/watch/?id=5205371n  Deception – The Notebook clip  http://www.youtube.com/watch?v=UZX_OxiSdSg  To old to vote? Is age even an issue to consider?  Grandparent’s raising grandchildren  Elder abuse  http://www.youtube.com/watch?v=5cauXgZhROM&feature=PlayList&p=033753054361E5CD&playnext_from=PL&index=0&playnext=1 http://www.youtube.com/watch?v=5cauXgZhROM&feature=PlayList&p=033753054361E5CD&playnext_from=PL&index=0&playnext=1  http://www.youtube.com/watch?v=OP0sZB9jRlA&feature=related http://www.youtube.com/watch?v=OP0sZB9jRlA&feature=related  Fraud  http://www.cbsnews.com/video/watch/?id=3249017n http://www.cbsnews.com/video/watch/?id=3249017n  http://abcnews.go.com/Business/video/elderly-scams-11121318 http://abcnews.go.com/Business/video/elderly-scams-11121318  Rationing of resources  http://www.youtube.com/watch?v=RiTp1w48P3E http://www.youtube.com/watch?v=RiTp1w48P3E