Ethical and Legal Issues in

Gerontological Nursing
 Ethico-legal Issues

Existing infringements
• Ageism
• Abuse
• Neglect
• Violence

http://www.un.org/esa/socdev/ageing/documents/egm/bonn09/report.pdf
 Ethico-legal Issues

Recommendations:
•Ageism: policies and public statements
•Abuse: enhance awareness; self-reporting
•Neglect, abuse , violence – data collection
towards preventive strategies
•Infrastucture to support mistreatment
•Advocacy and empowerment; access to services
•http://www.un.org/esa/socdev/ageing/documents/egm/bonn09/report.pdf
 Ethico-legal Issues

Common Issues confronting elder care providers:

 Actual conflicts of interest
spouses & their wishes versus the elder’s wishes & interests
care provider’s business interests versus the elder’s interests

Potential conflicts of interest

Confidentiality
Decision making capacity
•http://www.ensignlaw.com/Ethical%20Issues%20and%20Elderly.html
 Potential Legal Liability Acts

 Assault  Invasion of privacy

 Battery  Larceny

 Defamation of character
 Negligence*
 Libel & slander
 Malfeasance
 Misfeasance
 False Imprisonment
 Nonfeasance
 Criminal negligence
 Fraud
 Malpractice

 All of the following must be present for

malpractice to exist:

 a professional duty owed to the patient

 breach of such duty
 injury caused by the breach
 resulting damages
 Duty

 A relationship between the nurse and the patient in

which the nurse has assumed responsibility for the

care of the patient.

 Malpractice

 Negligence is:
 Failure to conform to the standard of care (i.e.
malpractice).

 Injury:
 Physical or mental harm to the patient or violation of the
patient’s rights resulting from the negligent act.
 Other Ethico-Legal Issues

 Decision making  Care and treatment

 Client’s ability  Level of care

 Appropriate surrogate  Basis of function

decision maker
 Termination of treatment
 Disclosure of information at end of life
to make informed
decisions
 Abuse
 Types of Abuse

 Physical abuse
 The willful infliction of physical pain or injury

 Financial abuse
 Theft or mismanagement of money or resources

 Social abuse
 Infliction of debilitating mental anguish and fear
 Abuse

 Neglect
 Failure of caregiver to provide necessary services
 Services for physical and mental health

 Violation of individual rights

 Unreasonable confinement
 Deprivation of services
 Exploitation
 The illegal use of a person or resources for another’s profit
 Elder Abuse

Complex:

 Family arrangements

 Carer issues

 Socio-cultural issues
Advanced Medical Directives
 Advanced Medical Directives

 Client’s wishes in different situations

 Documented preferences

 Living will
 Clients wishes re: medical treatment should s/he
become terminally ill

 Durable medical power of attorney

 Someone is designated to make health care decisions
when s/he is unable to do so
 Scenario

 Two months ago, Mr M.T. (80 years old) and his wife

were involved in a severe auto accident. Mrs. A T died.

Mr. M.T. previously told his 3 children that should he

ever become seriously injured or ill and unable to live his

life as he has in the past, he doesn’t wish to be treated

with extraordinary measures to continue his life.

 Scenario

 Two of the children agreed that their father would not want to
live with the residual effects of his injuries should he recover.
The third child, emotionally distant from the father until the last
6 months, desperately desires any relevant treatment for her
father to allow his possible recovery even if it means he has
decreased quality of life.
 Steps in the Process

Identify the issue

Whose decision is it?

Does an ethical dilemma exist?

 Identify ethical
principles

Relate principles
Yes
to facts

Does an ethical Appeal to an

issue exist? ethical theory

Resolve using
No usual problem
solving methods
 Identify
alternatives

Predict
Utilitarian ism
consequences

Identify positive
and negative
consequences
Appeal to an
ethical principle
Identify
alternatives

Rank ethical
Deontology principle(s) of
case

Resolution
 References

 II. Ageism: Concepts and theories http://www.lco-cdo.org/en/older-

adults-lco-funded-papers-charmaine-spencer-sectionII
 Biological theories of aging: Psychology of aging (2005).
http://flash.lakeheadu.ca/~mstones/Biological%20theories%20of%20a
ging.pdf
 Canning, D. (2011). Program on the global demography on
ageing. Working paper series - the causes and consequences
of the demographic transition
 References

 Ageism: Concepts and theorieshttp://www.lco-cdo.org/en/older-adults-lco-

funded-papers-charmaine-spencer-sectionII
Aging in the 21st century: A Celebration and a challenge
http://www.google.com.jm/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=
0CDkQFjAC&url=http%3A%2F%2Fwww.helpage.org%2Fdownload%2F50af6e9c8f44
b%2F&ei=BXOzUp6MBYPZkQebgYGwCA&usg=AFQjCNEOpxGzPhzfWrtQfQDMkA
oeONvSiw&sig2=HF6fZKB4_zXEmuKH99vIvw
 References

Desk Review: The situation of older persons in Jamaica (2011)

UNFPA and HelpAge International. Retrieved from http://
caribbean.unfpa.org/webdav/site/caribbean/shared/
publications/2011/Jamaica
Finalized_TheSitOlderPersonsInJamaica_UNFPA_030811-2.doc

•Eldemire-Shearer,D. (2008). Ageing. The response: Yesterday, Today and

Tomorrow. Retrieved from http://caribbean.scielo.org/scielo.php?
script=sci_arttext&pid=S0043-31442008000600009

Eliopoulos, C. (2010). Gerontology Nursing. Philadelphia: Wolters Kluwer Health/

Lippincott Williams & Wilkins.
 References

 Jamaica’s older person’s call for protection

http://www.jamaicaobserver.com/news/Jamaica-s-
older-persons-call-for-protection_12667661


 Mainstreaming ageing into national policy frameworks: An Introduction.

Retrieved from
https://www.un.org/ageing/documents/workshops/Vienna/issues.pdf
 Palmore, E., (1999). Ageism:Negative and positive.
Springer Publishing Co. 2nd ed. Retrieved from http://
books.google.com.jm/books?
id=Cg4_DTUuV4IC&dq=ageism+negative+and
+positive&source=gbs_navlinks_s
 References

• Perspectives on aging.(2007).
http://www.sagepub.com/upm-data/15090_Chapter1.pdf
 Political declaration and Madrid International Plan of action on ageing.(2002).
Second world assembly on aging. United Nations, New York
 Stewart, T.(2009). The elderly: sixty years and beyond. 2nd ed.
National Library of Jamaica
Thank you