Legal And Ethical Issues

Concerning Geriatric Nursing

Practice
NELIA S. BAÑAGA – PEREZ, RN, PhD, DNS
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REMINDERS:
1. Camera should be turned ON during
the class unless instructed to turn it
OFF.
2. Two devices are needed during
LONG EXAMS for monitoring if Cis
are not physically present.
3. PCU Uniform is the prescribed
DRESS CODE. In the absence of the
PCU Uniform, wear a plain white
Blouse or a Tshirt.
 Learning Objectives
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Adhere to ethico-legal considerations when providing safe and quality
nursing care of older adults.

Analyze the ethical reasoning and ethical practice of health care

professionals involved in the care of the older people.

Integrate knowledge of ethical principles in the consideration of ethical

dilemmas and their implications in the care of older person.
 Hello!
Please pay attention.
Whenever your NAME is called, your
recitation is GRADED.
Expect a quiz at the end of this lecture.

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6 1
Ethical And Legal Issues Concerning
the Elderly
 Ethical Issues
1. Autonomy and Informed Consent: As with all patients, respecting the
autonomy of elderly individuals is crucial. Nurses should ensure that older
adults are provided with adequate information to make informed decisions
about their care, taking into account their cognitive abilities and any
potential cognitive decline.
2. Beneficence and Non-Maleficence: Nurses have a duty to promote the
well-being of their patients and to do no harm. Balancing the benefits of
medical interventions with potential risks, especially in cases of serious
illness or advanced age, can be ethically complex.
3. Dignity and Respect: Older adults deserve to be treated with dignity and
respect, regardless of their health status. Nurses should address them by
their preferred names and ensure their privacy and modesty are preserved
during care.
 Ethical Issues (cont.)
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4. Quality of Life: Geriatric nurses often face decisions about treatments and
interventions that might extend life but could also impact the quality of that
life. Ethical considerations include understanding the patient's values and
preferences in relation to treatment options.
5. End-of-Life Care: Discussions about end-of-life care, including do-not-
resuscitate (DNR) orders and hospice care, require sensitivity and
consideration of the patient's wishes and cultural background.
6. Family Involvement: Family members often play a significant role in the
care of elderly patients. Ethical dilemmas can arise when patient wishes
conflict with family wishes. Geriatric nurses must navigate these situations
while ensuring patient autonomy is respected.
 Legal Issues:
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1. Healthcare Proxy and Power of Attorney: Nurses must be aware of legal
documents such as healthcare proxies and power of attorney that designate
decision-makers for elderly patients who may be unable to make decisions
for themselves.
2. Capacity Assessment: Determining an individual's capacity to make
decisions is important for obtaining informed consent. Geriatric nurses may
be involved in assessing capacity and ensuring that decision-making is legally
valid.
3. Elder Abuse and Neglect: Nurses have a legal obligation to report suspected
cases of elder abuse or neglect, whether it's physical, emotional, or financial.
Failure to report could result in legal consequences.
 4. Documentation: Accurate and thorough documentation is essential in
geriatric nursing to ensure legal accountability and to provide a clear record
10 of the care provided.
5. Advance Directives and Living Wills: Geriatric nurses should be familiar
with these legal documents that outline a patient's wishes regarding
medical treatment in case they become unable to communicate their
preferences.
6. Medication Management: Administering medications correctly and
documenting their administration is a legal responsibility. Elderly patients
often take multiple medications, increasing the risk of medication errors.
7. Privacy and Confidentiality: Just like with any patient, geriatric nurses
must adhere to strict privacy and confidentiality standards to protect the
personal and medical information of elderly patients.
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Professional Standards
12 ◈ Nursing standards of practice are measured
according to the expected level of
professional practice of those in similar roles
and clinical fields.
◈ A standard of care is a guideline for nursing
practice and establishes an expectation for the
nurse to provide safe, effective, and
appropriate care.
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◈ Professional standards describe the competent
level of care in each phase of the nursing
process.
◈ These standards are important to our
profession because they promote and guide
our clinical practice. 
 Salient Points
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◈ Philippine Professional Standards of Nursing
Practice
◈ Promulgation of Board of Nursing Code of
Ethics
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 Nursing Practice Standard Domains

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Relevant Laws in the Philippines

◈ Senior Citizen's Act  2010
◈ Implementing Rules and Regulations of the
Senior Citizen's Act
◈ Creation of National Commission of Senior
Citizen RA 11350
◈ Centenarian Law
◈ Senior Citizens and Philhealth
Older Adult Abuse and Protective
Services
Case Discussion
◈ You are the nurse in charge of a ward exclusive
for older patients. During rounds one evening,
an elderly, sometimes confused patient tells you
that a nurse aide “pushed her around” during
dinner that evening. What issues are presented,
and what actions should you take? How will you
deal with the patient's claim? Cite Laws that will
support your answer.
Autonomy and Self-Determination
Organizing  Concepts
1. Do Not Resuscitate Orders
2. Advance Medical Directives
a. Living Wills or Designation of Health Care agents
b. General Provisions in Living Wills
c. Durable (Lasting) or General Power of Attorney:
Differences and Indications
d. Decision Diagram
e. Conflicts Between Directives and Family Desires
Nurse’s Ethical Code
Ethical Dilemmas and Considerations
a. Euthanasia
b. b. Suicide
Experimentation and Research
 Euthanasia:
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◈ Autonomy vs. Sanctity of Life: Balancing an
individual's right to autonomy and control
over their own life with the belief in the
sanctity of life. The question arises whether a
person has the right to request assistance in
ending their life, even in cases of terminal
illness or unbearable suffering.
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◈ Pain and Suffering: Determining whether
severe pain and suffering should be considered
sufficient grounds for providing euthanasia.
This raises questions about the limits of
medical intervention and the ethical
responsibility to alleviate suffering.
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◈ Slippery Slope: The concern that legalizing
euthanasia may lead to a slippery slope where
it is extended to cases that were not originally
intended, potentially resulting in non-
voluntary euthanasia or abuse of the practice.
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◈ Role of Healthcare Professionals: The ethical
dilemma for healthcare professionals who may
be morally opposed to euthanasia but also
have a duty to respect patient autonomy and
provide compassionate care.
 Suicide:
30 ◈ Prevention vs. Autonomy: Balancing the duty
to prevent harm with the right of an individual
to make decisions about their own life. This
becomes particularly complex when dealing
with patients who express suicidal ideation.
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◈ Mental Health and Capacity: Ethical dilemmas
arise when individuals with mental health
issues express a desire to end their lives.
Determining their capacity to make rational
decisions about life and death becomes
challenging.
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◈ Involuntary Hospitalization: When an
individual is at risk of suicide, the ethical
dilemma involves deciding whether
involuntary hospitalization is justified to
protect their safety.
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◈ Communication and Confidentiality: Striking
a balance between respecting a patient's
confidentiality and involving others, such as
family members or mental health
professionals, when a patient expresses
suicidal thoughts.
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◈ Cultural and Religious Beliefs: Ethical
dilemmas arise when patients' cultural or
religious beliefs may influence their view on
suicide. Healthcare professionals must
navigate how to provide care that respects
these beliefs while also ensuring the patient's
safety.

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◈ Medical Assistance in Dying: In cases where
individuals have a terminal illness, there can
be ethical dilemmas around offering medical
assistance in dying (MAID) as a means to end
their life on their terms.