Miar Yosef Abuasad

20170704
Dr. Yosef Khalifa
Assignment 2
legal and ethical issues related to aging

The Aged Care Quality Standards

:The eight Standards are

Consumer dignity and choice .1

What this means for you

I am treated with dignity and respect, and can maintain my identity. I can make
.informed choices about my care and services, and live the life I choose

consumer dignitiy icon

Ongoing assessment and planning .2
What this means for you

I am a partner in ongoing assessment and planning that helps me get the care and
.services I need for my health and well-being

people sitting around table

Personal care and clinical care .3
What this means for you

I get personal care, clinical care, or both personal care and clinical care, that is safe
.and right for me

personal hygiene items

Services and supports for daily living .4
What this means for you
I get the services and supports for daily living that are important for my health and
.well-being and that enable me to do the things I want to do

tea and conversation

Organisation’s service environment .5
What this means for you

I feel I belong and I am safe and comfortable in the organisation’s service

.environment

house
Feedback and complaints .6
What this means for you

I feel safe and am encouraged and supported to give feedback and make
complaints. I am engaged in processes to address my feedback and complaints, and
.appropriate action is taken

ratings
Human resources .7
What this means for you

I get quality care and services when I need them from people who are
.knowledgeable, capable and caring

form and person

Organisational governance .8
What this means for you

I am confident the organisation is well run. I am a partner in improving the delivery of

.care and services

Older patients typically suffer from multiple diseases that

contribute to a high prevalence of malnutrition.15-17 In
disabled elderly persons, the benefits of nutrition support
have been essentially documented in terms of weight gain
and increased caloric intake. However, it remains unclear
whether these improvements translate into other benefits
,such as reduced in-hospital morbidity (eg, infections
pressure sores) and mortality, improved functional ability
and quality of life, or outcomes, especially in older
patients.18-23 A Cochrane review24 investigated the benefits
of oral nutrition supplementation in elderly people at risk
of malnutrition (55 trials, n = 9187 randomly assigned
-participants) and provided mixed results. Nutrition sup
plementation was associated with fewer complications
and reduced mortality in acutely ill, malnourished older
-inpatients. In contrast, patients living at home only mod
estly improved their weight but had unchanged mortality
-and functional status. Furthermore, the overall method
ological quality of the reviewed studies was judged as
,poor, with several major methodological limitations
including (but not limited to) the absence of blinding in
,treatment allocation as well as outcome assessment
unclear randomization processes, or lack of monitoring of
nutrition intake. The heterogeneity of these results
-prompts subsequent attempts to better delineate indica
tions for nutrition supplements and tube feeding in older
patients.25
In older patients suffering from dementia, EN is even
more controversial.26-30 Even though few studies found
that nutrition support significantly improved weight in
patients with Alzheimer disease, these benefits do not
translate into positive changes in cognitive ability or in
-activities of daily living performances.30 There is no evi
-dence that tube feeding would prevent aspiration pneu
monia, prolong survival, reduce the risk of pressure sores
or infections, improve function, or provide palliation in
patients with advanced dementia.26 Moreover, several
studies suggest that harm is substantial and may well
exceed the benefits in these patients.26,31 Side effects of
-nutrition delivered through percutaneous enteral gastros
tomy (PEG) have been described in dementia patients31
-and include aspiration, infection, increased oral secre
.tions, tube malfunction, and discomfort
In summary, evidence is still lacking regarding the
benefits in function, mobility, or quality of life resulting
-from nutrition support in disabled older adults. In par
ticular, risks associated with the PEG procedure might
-well exceed potential benefits in those most severely disa
.bled, such as patients with dementia

Ethical Framework
,Despite the development of evidence-based medicine
decision making remains a difficult process in older
-patients where multimorbidity limits guideline applicabil
ity. To tackle complex issues in care and provide patients
with the best possible option, health professionals need to
use all available evidence. However, health professionals
also need to incorporate factors such as personal values or
past experiences and to rely on ethical principles and legal
standards to navigate through ethical decision making.32
-Medical ethics is based on a series of ethical princi
ples that are particularly relevant to medical practice and
Autonomy This principle guarantees that competent
patients have the right to accept or refuse
-a given plan of care, without being influ
.enced by an outside authority
-Beneficence This principle implies that medical practi
tioners should act in the best interest of
.the patient
-Nonmaleficence This principle implies that medical practi
.tioners should not harm the patient
Distributive
justice
-This principle implies that health profes
sionals should be aware of distributing
healthcare resources in a fair way among
.the members of society
Dignity This principle implies that a person has an
.innate right to respect and ethical treatment
-Integrity This principle implies respect of the whole
.ness of the human person
Vulnerability Vulnerability refers to the fragility of an
intact but destructible human totality and
,takes into account the biological, social
and cultural characteristics of the person
.living in the modern technological world
It expresses the finitude of the human
condition. Vulnerable persons are those
whose autonomy, integrity, and dignity are
.capable of being threatened

Description of the Guide for Ethical Reflection

-Application of guide for ethical reflection is best per
formed through a formal deliberative meeting that gets
.together all health professionals involved in the situation
They discuss the situation using an 8-step process that is
summarized. The proposed process has been
-previously described by one of the authors.40 The meet
ing’s ultimate goals are to achieve a consensus on the best
option to manage the situation and to define a coherent
.attitude within the team
To achieve the best chance of success and reach
these goals, health professionals should be aware of
what the patient, as well as possibly what the patient’s
family, wants and expresses. This information is usually
gathered through prior meetings with them, either
-together or separately. Professionals also need to care
fully collect information about values supported by
-other stakeholders (eg, other relatives and health profes
sionals). The deliberation process should then take
place without the patient or his or her family. Including
patients or families in such a meeting would reveal
health professionals’ uncertainties to vulnerable patients
.and relatives, and potential conflicts could worry them
-However, conclusions of the deliberation are subse
quently transmitted to the patient, and possibly his or
her family, to reach a consensual plan of care and
.ensure their adherence

Concrete Conditions Required to Use the

Guide for Ethical Reflection
History, context, and reframing of the ethical question
-Identify the clinically relevant facts and clarify the ethi
.)cal question(s
-Identify the patient’s sociofamilial context and all stake
.holders involved in the situation
Care responsibilities and values of each stakeholder
.Identify the care responsibilities of each stakeholder
Identify the values considered by each stakeholder as
essential to address the ethical questions. This step
.includes identification of cultural and religious values
Ethical analysis of the clinical situation
-Analyze the ethical conflicts at stake in the clinical situa
.tion
Medical options
.Identify all possible options to solve the ethical conflicts
Identify the consensual option that best integrates values
.of the patient, stakeholders, and health professionals
Moral justification
.Discuss the moral justification for the choice

The Four Principles of Health Care Ethics for elderly

There are four commonly accepted principles of health care ethics that providers
follow to ensure optimal patient safety: autonomy, beneficence, non-maleficence,
and justice. Let’s take a closer look at the definition of each of these principles and
.how they are put into practice in the home health care environment

Autonomy
In the medical field, autonomy refers to the right of the patient to retain control over
.his or her body

Patient autonomy is also critical when it comes to how home health care agencies
handle incapacitated patient and life-sustaining treatment decisions and the
procedures providers have in place. Consistent written policies and training are both
.needed for nurses, aides and other staff to handle such difficult ethical dilemmas

Beneficence
Health care providers are charged with doing all they can to benefit a patient, with all
recommended procedures and treatments intended to do the most good for the
patient. In order to do this, a high level of skill and knowledge, including ongoing
..training is needed

Non-Maleficence
This principle is about “doing no harm”, intended for providers to consider if any
decision made may harm another individual or society – even it is made to benefit an
individual patient. This is why it’s so important for home health care agencies to
implement strong risk management strategies, safety procedures and protocols and
best practices for staff to follow. When staff members are well versed in – and
understand – a provider’s protocols, there is less room for deviation or exceptions
that, while perhaps performed with good intentions, can cause overall harm and
.liability issues for the provider

Justice
The principle of justice states that there should be an element of fairness in all
medical decisions. This means fairness in decisions that burden and benefit, as well
as equal allocation of health care dollars and resources, and for medical practitioners
to uphold applicable laws and legislation when making choices. For home health
providers, it means having a policy in place to provide care, treatment and services
to patients without regard to age, race, religion, sex, national origin or disability. It
also requires providers to ensure they are in compliance with both federal and state
.regulations that govern them

‫اعتذر عن سوء التنسيق بسبب استخدام الجوال‬

‫الرجاء فتح باب التسليم للتكاليف السابقة بسبب اغالق المودل لم أتمكن من التسليم‬