CARE OF THE ELDERLY AND
2.9 THE CHRONICALLY ILL
Ethical Issues in Organ Transplant
Ethical Principles
Ethical Issues: Selection Of Recipient
General Guidelines
Ethical Principles
• Autonomy
- The right to self-determination
• Informed Consent
- Legal doctrine requiring full disclosure
• Beneficence
• Non-maleficence
• Justice
- Equal allocation of treatment to all
Competency
• Essentially the ability to make a decision
• Patient is competent:
1. he has an understanding of the situation & the
consequences of decision
2. the decision is based on rational reasons
Guide questions for determining competency of Patients
who refuse medical treatment:
1. Does the patient understand his medical condition?
2. Does the patient understand the options and
consequences of his decision?
3. Does the patient refuse medical treatment based on
rational reasons?
4. If the patient refuses treatment based on religious
beliefs , are religious beliefs held by a sufficient
number of persons for a sufficient period of time?
Decision-making capacity
• Necessary in order to be autonomous and participate
in informed consent
• Ability to communicate a choice
• Manipulate rationally the information necessary to
make the choice
• Reason consistently with previously expressed
values and goals
• If a patient in incapable of decision making, the
clinician should identify an appropriate surrogate
decision maker
Advance Care Planning
• Allows patients to identify health care preferences
and surrogate decision makers in the event the
patient cannot make health care decisions
• Patient-clinician discussion of future and end- of-life
care and the completion of an advance directive
Advanced Directives
- creates a mechanism for capable adults to anticipate
future scenarios and instruct their physicians
prospectively regarding the use of life-sustaining
medical treatment
- promotes autonomy of patients who once possessed
but now lacks decision making capacity
Allocation of Resources
Principles Involved
Entry to Transplantation Program
Ethics of Organ Selling/Buying
Virtues of A Catholic Health Care Giver
2 Forms of Advance Directives:
1. Living will
- based theoretically in the right that all competent
person have the right to refuse treatment or extra-
ordinary measures
- try to provide a mechanism for determining the
wishes of an incompetent patients and carrying
them out
- list of interventions and other actions that should
or should not be taken in specific circumstances
- try to put the responsibility where it is perceived
to belong – on the patient – by ensuring that the
person’s wishes will be respected even when
he/she cannot speak directly to this particular
situation
2. Durable power of attorney for health
- identifies surrogate decision maker in the even
the patient lacks decision making capacity
- legal document, authorized by the state
- Voluntarily delegating or directing future medical
decision-making power
- A competent individual (principal) directs, through
the appointment of an agent (attorney in fact,
need not be an attorney at law), the making of
medical decisions in the event of future incapacity
Surrogate Decision Maker
- One who best understands the patient’s health care
values and goals
- Usually family members
- Court-appointed guardian, spouse, next of kin
- Surrogate decision makers should base their
decision on the patient’s previously expressed
values and goals
Withdrawing & Withholding Life-Sustaining Interventions
• Justifiable if:
✓ If the patients who requested have adequate
decision making capacity
✓ If it no longer offers benefit to the patient
✓ Withdrawing and withholding life-sustaining
interventions is NOT the same as Euthanasia
Allocating Health Care Resources
• Rationing occurs when a clinician withholds a
medically beneficial intervention because of its cost
to someone other than the patient
• The ethical principle of justice refers to the duty to
treat individuals fairly
• Injustice occurs when health care decisions are
based on irrelevant patient-specific factors such as
age rather than on the medical need
Recommending to Nursing Home
• Assisted living
• Consider if:
– Physically disabled
– Cognitively impaired – Elderly
– Poor
– Loss of Social Support
• Primary reason for recommending patients to Nursing
Homes should be safety
• What to look for in a Nursing Home:
– Meets the level of care needed
– Geriatric Experience
– Regular Medical Checkups
– Facility Design
– Medical Emergency Procedures
• Elderly, poor, physically-disabled, and cognitively
impaired, loss of social support
• Safety is of the reason for offering nursing home care
• Autonomy vs Safety
• Must regard the benefits of nursing home care as
greater than the harms
• Allows patients to identify health care preferences
Laws protecting the rights of Elderly
1986 Constitution
Article II, Section 9: “The state shall promote a just and
dynamic social order that will ensure the prosperity
and independence of the nation and free the people
from poverty through policies that provide adequate
social services, promote full employment, a rising
standard of living, and an improved quality of life for
all”
Article XIII, Section 11: “The state shall adopt an
integrated and comprehensive approach to health
development which shall endeavor to make essential
goods, health and social services available to all
people at affordable cost. There shall be priority for
the needs of the unprivileged, sick, elderly, elderly
disabled, women, and children. The State shall
endeavor to provide free medical care to paupers”.
Article XV, Section 4: “The family has the duty to care
for its elderly members although the State may also
do so through just programs of although the State
may also do so through just programs of social
security”.
Article XVI of Section 8: “The State shall from time to
time, review and upgrade the pensions and other
benefits due to retirees of both the government and
private sector.”
Expanded Senior Citizens Act of 2010
- Republic Act No. 9994
- An act granting additional benefits and privileges to
senior citizens, further amending RA 7432, as
amended, otherwise known as "an act to maximize
the contribution of senior citizens to nation building,
grant benefits and special privileges and for other
purposes“
Sec 4
– 20% discount and exemption from VAT
– 5% to the monthly utilization of water and electricity
Pension System:
Social Security System
- Renders services to private and self-employed
retirees
- Must be at least 60 years old and paid 120 monthly
contributions to avail retirement benefit
- Contributions can be paid either monthly or by lump
sum
- Lowest monthly pension:
• Php 1200 if member has 120 monthly contribution
• Php 2400 if member has at least 20 credited years
of service
Government Service Insurance System
- Mainly for public sector workers
- The Government Service Insurance Act of 1997
• Increase monthly pension from Php 2700 to Php
9000
- Conditions for Retirement Benefit:
• At least 60 y/o
• At least 15 years of service
• Not receiving a monthly pension benefit from
permanent total disability
Philippine Veterans Affairs Office
- Benefit programs for veterans
- Mainly composed of veterans from World War II
Welfare Services
- Undertaken mainly through the Department of
Social Welfare and Development
- Elderly Group is one of the 13 categories under
“Disabled Persons”, under subheading “Socially
Disabled”
- Programs and service planned for the elderly
based on the following principles:
• Right to have access to services and opportunities
that will help him achieve a productive,
wholesome and satisfying life
• Family & community responsibility in recognizing
the potentials of elderly persons and the need to
provide opportunities to make minimum use of
such potentials
• Government’s responsibility to provide basic and
essential services for the elderly
• Care for the Elderly
– Homes for the Aged
– Senior Citizens Center
– Discounts and Privileges
– Medical Dental Care
• Elderly Volunteer Program
– Resource Volunteer Service
– Foster Grandparents Services
– Peer Support Group
– Peer Outreach/Respite Services
– Family Enrichment Services
– Neighborhood Watch
– Sponsorship Program
• Training of Elderly
– Livelihood Development Service
Elderly Abuse
4 categories:
• Physical Abuse
- acts committed with intention of causing physical
pain and injury
• Psychological/Emotional Abuse
- involves verbal assaults, threats, humiliation and
ridicule
• Material or Financial Exploitation
- misuse of property or money, theft, or forced
signing of legal documents
• Neglect
- Passive or Unintentional Neglect: Isolation of the
elderly
- Active/ Intentional Neglect: Deliberate withholding
of items needed for daily living
Leisure Activities
- Vital in the daily life of the elderly
- Two most frequent forms of recreation:
• Radio Listening & TV Watching
- Chatting withers serves as major mode of satisfying of
social needs of the elderly
- Attending religious gatherings and activities is another
significant past time for the elderly in the Philippines
- Section 4: Privileges for the Senior Citizens
• Educational assistance
• Special discounts on purchase of basic
commodities
• Express lanes
- Section 5: Government assistance
• Employment
• Education
• Health
• Social services
• Housing
• Access to public transport
Expanded Senior Citizens Act of 2010 (RA 9994)
- an act granting additional benefits and privileges to
senior citizens, further amending RA 7432 of 1992
as amended by RA 9257 of 2003
- aims to give flesh to the “social justice clause”
- Article 7: Grant of 20% discount & VAT exemption
• Section 1: Medical-related privileges
• Section 2: Domestic transportation privileges
• Section 3: Hotel and restaurant privileges
• Section 4: Recreation centers
• Section 5: Admission fess privilege
• Section 6: Funeral and burial services

Current Legislation for the Elderly

Senior Citizens Act (RA 7432)
- an act to maximize the contribution of senior
citizens to nation building, grant benefits and
special privileges, and for other purposes
- approved on April 23, 1992
- Section 2: Definition of Terms
• Senior citizen: any resident of the Philippines at
least 60 years old, retired, and has an income of
not more than sixty thousand pesos per annum
- Section 4: Privileges for the Senior Citizens
• Grant of 20% discount
• Exemption from payment of income taxes and
training fees for socioeconomic programs
• Free medical and dental services in government
establishments
- Section 5: Government assistance
- Section 6: Retirement benefits
Senior Citizens Center Act of the Philippines
(RA 7876)
- an act establishing a senior citizens center in all
cities and municipalities of the Philippines and
appropriating funds
- Section 5: Functions of the Centers
• Identify needs, trainings, and opportunities
• Initiate, develop, and implement productive
activities and work schemes
• Promote and maintain linkages for the delivery
of health care

Expanded Senior Citizens Act of 2003 (RA 9257)

- an act granting additional benefits and privileges to
senior citizens amending for the purpose RA 7432
- Approved: February 26, 2004