Ethics and the Care of Persons Living with Dementia

Outline:
I.Introduction

A.Ethical principles

1.Autonomy

2.Beneficence

3.Justice

4.Non-maleficence

B.Course objectives

C.Glossary

1.Autonomy

2.Beneficence

3.Bill of rights

4.Code of ethics

5.Ethics

6.Justice

7.Non-maleficence

II.What are ethics?

A.How to live a good life

B.Rights and responsibilities

C.Right and wrong

D.Good or bad

E.Finding the right ethical response

1.Consequence theory

2.Duty theory

3.Principle theory

F.Ethics in care settings

1.Laws protect residents

2.Ethics protect residents

3.Checkpoint:Question(multiple choice)

G.What is autonomy?

1.Independence in thoughts and actions

2.Freedom in decision-making

3.Respecting autonomy

a.Promote and protect rights

b.Encourage choices even for the person living with dementia

H.Decision-making capacity

1.Situation and context specific

I.Evaluating decision-making capacity

1.Will it cause harm to self or others?

2.Can the person understand possible risks and benefits?

3.Is there consistency across time?

4.Checkpoint:Question(multiple choice)

J.Surrogate decision-making

1.State law

2.Advanced directives

3.Guardianship

K.Supported decision-making

1.Share information

2.Offer respect and support

3.What would your loved one want?

4.Reflect on history and preferences

5.Checkpoint:Question(true/false)

L.Case study-Jim and Mary

1.Jim's choice to live where he wants to even though his daughter wants him to move

2.Ethical decision-making considerations

a.Who has the authority and right to make the decision?

b.The role of healthcare surrogate

c.What should the staff of the care setting do?

d.What other underlying issues may be present?

M.Beneficence

1.Promotes well-being

2.Prevents harm and suffering

3.Improves situations

N.Ethical conflicts

1.Autonomy versus beneficence

2.Things to consider

a.The right level of autonomy supports beneficence

b.Encouragement versus control

3.Autonomy and beneficence

a.Find the right strategy

b.Avoid restraints

i.Least restrictive alternative

a)Limits are no greater than is necessary

ii.Falls

a)Screening

b)Prevention

c)Individual assessment and strategies

c.Checkpoint:Question(multiple choice)

4.Beneficence summary

a.Case study-Eleanor

i.Beneficence versus autonomy:fell and didn't want to go to the hospital for care

ii.Ethical considerations

a)What is best for Eleanor?

b)Ethical principals involved

c)Was the ethical decision made?

d)Why is applying ethical principles so complex?

e)What was the outcome?

O.Justice

1.Fair, equitable standard of care

2.Rooted in democracy

3.Basic rights

a.Dignity and respect

b.Individualized care

c.Non-discrimination

d.Free from abuse or neglect

4.Stigma

a.Labeling

b.Negative attitudes

c.A form of discrimination

5.Checkpoint:Question(multiple choice)

6.Burden to society

a.History of discrimination

b.Fears

7.Stereotyping

8.Social justice

a.Human rights

b.Non-stigmatizing

c.Person-centered care

d.Is inclusive

e.Creates standards

f.Monitors

g.Empowers

h.Checkpoint:Fill in the blank

9.Resident rights

a.Safe living environment

b.Consideration and respect

c.Control of private property

d.Private communication

e.Community services and activities

f. Manage financial affairs

g.Share room with spouse

h.Exercise civil and religious liberties

i.Access to appropriate care

j.To be notified in advance of a move

k.To express grievances

10.Checkpoint:Question(multiple choice)

11.Oversight and monitoring

a.To ensure the ethical principle of justice is put in practice

b.State

i.Inspection

ii.Complaints

iii.Investigations

12.Ethical principle of justice

a.Case study-Laura and Mark, residents who like being in each other's company; Mark has a wife who lives at her own home and wants him kept away from Laura

i.What should the staff do?

ii.What staff members are involved in this ethical concern?

iii.What are the ethical concerns and principles?

iv.Is wandering a consideration?

v.Should Laura have to move?

vi.What else could be tried?

P.Non-maleficence

1.First, do no harm

2.Autonomy versus beneficence and non-maleficence

3.Case study-Mrs. Delgado, living with dementia, takes a medication that helps her anxiety; she is refusing the medication, and staff members want to hide the medication in ice cream

a.What should the staff do?

b.Risks and guidelines

c.Non-drug interventions

III.Summary and conclusion

A.Consider the ethical principles of autonomy, beneficence, justice, and non-maleficence

B.People living with dementia have rights and can still enjoy life

C.Balance safety and freedom

D.Focus on care that is person centered

IV.Final exam(post-test

Catherine Zimmerman is a licensed independent clinical social worker who has a private practice providing counseling services to people of all ages and all stages of their lives. She is a freelance healthcare writer and speaker specializing in mental health, ethics, hospice and palliative care, gerontological topics, substance misuse, caregiving, stress and trauma.  Zimmerman received her master's degree from Portland State University thirty years ago and is certified in clinical social work-Gerontology. Zimmerman supervises and mentors therapists seeking licensure in Oregon or Washington states. She is the current President of the Washington chapter of the National Association of Social Workers and has provided public presentations on over twenty topics and has numerous published works.

Cynthia McDaniel MSN RN, is a nurse and administrative consultant in long term care. She is the CEO of ElderWise Inc, a senior living consulting and education group. Cynthia has worked as a nurse consultant for the States of Oregon and Washington,  a geriatric care manager, a regional director of clinical operations for a senior living company, and an assistant professor at Oregon Health & Science University School of Nursing. Her research in assisted living focused on the characteristics of residents in assisted living communities and the role of the nurse in assisted living. Cynthia holds a Master's of Science in Nursing from Gonzaga University in nursing education. She is a Fellow of the Sigma Theta Tau/John A. Hartford Foundation Geriatric Nursing Leadership Academy.