Ethics in Disabled, Children and Elderly Individuals PDF

Professional Ethics Ethics in Disabled, Children and Elderly Individuals Onur TURAN PT, PhD(c), Lecturer Ethics in Disabled, Children and Elderly Individuals Learning Outcomes; 1. Defines ethical principles for people with disabilities 2. Defines ethical principle...

Professional Ethics Ethics in Disabled, Children and Elderly Individuals Onur TURAN PT, PhD(c), Lecturer Ethics in Disabled, Children and Elderly Individuals Learning Outcomes; 1. Defines ethical principles for people with disabilities 2. Defines ethical principles in children. 3. Defines ethical principles in elderly individuals. Disabled and Ethics The World Health Organization (WHO) states that disability is a concept that includes extremely different problems and that while some disabled individuals have comprehensive health care needs, others may not have such special needs. According to the United Nations convention on the Rights of Persons with Disabilities, persons with disabilities should have access to the highest standard of health care without any discrimination. However, scientific research on the subject shows that the health care needs of disabled individuals are not adequately met.  In addition to not being able to benefit from health care and treatment services adequately, health promotion and prevention efforts unfortunately do not adequately address disabled individuals as a target audience. A study conducted in the USA found that only half Disabled and of disabled individuals diagnosed with cerebral palsy, multiple sclerosis, spinal cord injury and Ethics arthritis were able to access the rehabilitation services they needed. Moreover, it has been stated that disabled individuals with the lowest health status and income levels are the ones who suffer the most from this situation.  In our country, in recent years, it is possible to receive services from official and private care centers for disabled individuals under the leadership of the Ministry of Family, Labor and Social Services, and to additionally benefit from home care services. Disabled and MoFLSS acts with the responsibility of identifying, protecting, caring for and rehabilitating disabled Ethics individuals and planning services that enable them to live independently in society, carrying out services that will provide continuous care to disabled people who cannot benefit from these services, opening organizations and directing the service. Disabled and Ethics Although these initiatives in our country have improved the issue, there are still some psychosocial and physical obstacles that prevent disabled individuals from benefiting from health services. Physical disabilities mainly mean accessibility-related problems. For example, a female patient in a wheelchair must be standing in order to have a mammogram. This indicates a problem with the accessibility of medical services.  On the other hand, individuals with disabilities may avoid reporting symptoms associated with shame, such as urinary incontinence, to healthcare professionals. Such inadequate information transfer also prevents disabled individuals from reaching the desired Disabled quality of the treatment services they receive. In order to overcome this problem, there must be a and Ethics sufficient number of health professionals such as physicians or nurses and they must be able to spare enough time to question the conditions of disabled patients. Unfortunately, it is not always possible to adequately care for disabled individuals in hospitals due to the density of patients and lack of staff.  People from all layers of society may have negative attitudes towards disabled individuals. Healthcare professionals may provide limited or low-quality services to disabled individuals due to their negative attitudes towards them. As a result, the behavior of disabled individuals Disabled in receiving health services decreases. A medical doctor's attitudes towards disabled and Ethics patients affect the provision of appropriate care, as well as determine the patient's response to treatment and treatment outcomes. In addition, the attitudes of medical doctors can also affect institutional and societal policies regarding the resources allocated to disabled patients. Disabled and Ethics Individuals with disabilities should have access to the highest standard of health care without any discrimination. Health professionals should be made aware of individuals with disabilities and should be included in continuing education programs on this subject. Physical and psychosocial factors that prevent disabled individuals from benefiting from health care services should be identified and improved. Communication with Disabled Individuals We can list general tips on communicating with disabled individuals in accordance with ethical rules as follows: First of all, see the people themselves, not their disability. Focus on people themselves, not their attributes. If you are going to communicate with a disabled person for the first time, act with the assumption of the highest possible physical and mental ability. You can make adaptations according to your disability if necessary. When you meet a person with a disability, behave the same way you would when meeting any other person. Accept them as individuals, regardless of whether they are adults or young people. Talk to a person with a disability the same way you talk to other people. Communication with Disabled Individuals Relax. Don't feel bad when you use familiar expressions such as "see you soon" or "have you heard" that are not appropriate for the person's disability. Update the language you are using. Point out the other person's skills rather than their shortcomings. Avoid false or excessively literary expressions. Avoid using accusatory or pitying expressions when talking about people with disabilities. Such statements trigger dramatic thoughts about the disabled individual. Communication with Disabled Individuals Choose words that make you feel good when communicating with a disabled person. When you choose positive words, you empower the other person. For example, the person with a developmental disability Person with a disability (rather than a disabled person) Person with muscle disease (rather than a muscle disease victim) Person using a wheelchair (rather than a wheelchair-bound/dependent person) Person without disability (instead of normal) Person who cannot speak (instead of dumb) When you offer help, do not take action until your suggestion is accepted, do not make assumptions, ask what you need to do and listen to the answer and implement it. Do not be insistent and hasty. Even if your request for help is denied, do not be shy. Do not hesitate to ask when you are not sure what to do; Know that asking questions where necessary shows the value and importance you give to the disabled person.  Disabled My disabled brother Spastic, epileptic I love disabled people very much We are all disabled people. …. victim Disabled people need our attention/help. ….useless Communication You can't do it like this / can you? ….deformed with Disabled Stupid Real disabled people are individuals whose disabilities are Individuals Child/student in need of visible. Only after the problems of care/attention "normal" individuals are solved Schizophrenic can the problems of "DISABLED" individuals be dealt with. Poor Children and Ethics The concept of child has a special place in terms of social status. This is also of great importance for the patient groups and practices of the medical profession. A child is a person who is intellectually and linguistically alien to adults, has deficiencies in the ability to count, classify and generalize logically, and has emotional differences. Due to these characteristics, pediatric patients are considered vulnerable groups in medicine. Therefore, this should be taken into consideration in diagnosis and treatment methods and medical research practices. Children and Ethics When children are mentioned, we are talking about individuals who occupy a certain area of social life and are kept in a separate place from adults due to age. Although the age limits vary according to geographical and climatic characteristics, childhood stages cover certain time periods. It is possible to briefly group these under the headings of newborn (0-2 months), early childhood (15 months-4 years), middle childhood (5-10 years), adolescence (11-21 years). Ethical Issues in Pediatric Cases Some of the main issues concerning child ethics are as follows: Informed (informed) consent-consent Decisions of the family on the child in medical problems decision-making ability and the child Treatment denial-euthanasia The situation of children who have reached the end of their life in intensive care units The situation of pediatric patients whose prognosis is hopeless Children in medical research Ethical Issues in Pediatric Cases The most important ethical problems we encounter in the field of children are that the child should be evaluated as a person and that he/she has the right to respect, care and protection that people should have, autonomy and decision-making about himself/herself. There are different views, but it is still possible to agree on some principles. Ethical Issues in Pediatric Cases If the child is too young and inexperienced to make decisions that can be considered autonomous, and if it is impossible to eliminate the defects that threaten his autonomy for the same reasons, paternal (parenteral) intervention to prevent the child from falling into distressing situations will be absolutely justified. However, if the child is capable of making highly autonomous decisions, or if he/she can make decisions if the necessary assistance is provided to eliminate the defects, then he/she should be allowed to make decisions on his/her own. For example, if a child is so afraid of getting an injection that he refuses, say, an antibiotic or a rabies vaccine or a snake serum that would save his life, it is of course correct that this child should be considered incapable of making an autonomous choice. Ethical Issues in Pediatric Cases In addition to informing the parent or guardian who has decision-making authority on behalf of the child regarding the child's medical condition, the child also needs some kind of approval and simple information that is believed to be sufficient. It is stated that the age process here is around 14-15. In some studies, the beginning of this age group is given as 7-8 years old. The 14-15 age group mentioned here is about the child's decision-making participation and approval in the relevant diagnosis and treatment process. Ethical Issues in Pediatric Cases In ethical reports on children in medicine, the general rules regarding the position of the child have been extended by UNICEF. According to this; The personality and rights of each child will be given importance under all circumstances, their rights will be carefully protected in research on children, age and developmental process will be valued, even if the child's name is not used or his image is changed beyond recognition, a story or picture that will harm his personality will not be published. Mother and father, who are primarily responsible for decisions about the child, want to make the best decision and choice on behalf of their child. However, the responsibility of the doctor in the decisions to be made on behalf of the medical treatment of the child is greater, and these can often coincide with critically distressing and problematic situations. For example, there may be significant differences between a health problem experienced by a preterm child and a normal and full-term baby, and the doctor may have to consider the issue separately in terms of preterm and normal term infants when evaluating both conditions. Ethical Issues in Pediatric Cases Although the World Medical Association's declaration on the rights of the child in health care recommends that the child's wishes and desires be taken into account in diagnostic, treatment, rehabilitation medical practices or scientific research, it is still emphasized that consent must be obtained from the family or legal representative.  In adult patients, we can talk about patient autonomy within certain conditions. However, is there a reason to limit autonomy for Ethical patients under 18 years of age? In this context, the principle of respect for patient Issues in autonomy and informed consent should be separately considered in pediatric patients. The most important ethical element regarding informed Pediatric consent in pediatric patients is the issue of adequacy. The importance of protecting children's rights is Cases often pointed out by assuming that children have limited or no decision-making ability, that is, by questioning their competence. The child's age and social and intellectual development are of great importance in terms of competence. Ethical Issues in Pediatric Cases For this reason, doctors have to get permission from their parents in order to perform the treatment in terms of ethics and legality in pediatric patients. Likewise, it is important that the medical team is in contact with the family in case of problems experienced during the treatment of pediatric patients. Doctors who treat adults, including children, without parental consent are at risk from a legal standpoint. However, this risk remains at the theoretical level in the USA. In this country, in the last 10 years, no court has held doctors responsible for not obtaining consent from their families regarding children aged 15 and over who gave consent. The families also did not attempt to object to the medical decision on this issue. Ethical Issues in Pediatric Cases However, it may always be doubtful whether the parents can take the most valid and correct decision regarding the child's illness. For example, the case in Saskatchewan (Canada) in November 1998 relates to this. When thirteen-year-old Tyrell Dueck is diagnosed with osteosarcoma (osteogenic sarcoma), the patient's cancer team recommends chemotherapy and the amputation of one of his legs. However, the patient's parents state that they reject traditional treatment according to their Christian beliefs and instead want treatment at a center in Mexico that provides other treatments. Tyrell's father is in favor of the clinical team not having a discussion with his children about it while they are away. According to the family cancer team, osteosarcoma cases show a 65% survival rate under appropriate treatment. However, other treatment methods have no proven data on this subject. What do you think happened? Ethical Issues in Pediatric Cases Another well-known example of the active role of parents in the decision-making process is the “Baby Doe” phenomenon. Baby Doe was born in April 1982 with Down syndrome, tracheoesophageal fistula, and esophageal atresia. The family did not accept the surgical interventions planned for this baby. The child had a chance to undergo surgery and live with a mental disability. However, although the baby's doctors went against the family's will and appealed to the court, the court ruled that the family had full authority. Thereupon, a regulation was later issued in 1984 and it was stated that doctors are obliged to ensure that newborns survive, no matter how severe the degree of congenital defect and how low the chance of survival is. These studies were called Baby Doe regulations (Child Abuse Prevention and Treatment Act 1984). It was referred to as. Ethical Issues in Pediatric Cases Another situation that creates an ethical problem regarding parents' consent and authority for medical procedures to be performed on their children is the fact that the child's opinion is not taken into account during the decision-making process on behalf of the child for circumcision, which is a traditional approach of certain religions (Islam, Judaism). According to some accepted ethical literature texts, it is stated that it is wrong for parents to be the only competent decision-making authority regarding the child's circumcision, and it is recommended that such initiatives be postponed until the child is old enough to make a decision. The point to be emphasized here is that parents are authorized only for the diagnosis and treatment of the child's diseases, and circumcision is outside this scope. Children and Ethics Facts regarding informed consent in pediatric patients can be listed as follows: All pediatric patients should be informed about their diseases and treatments in accordance with their understanding abilities and their questions should be answered, For pediatric patients, "informed consent" or "permission" must be legally obtained from the mother and father. In addition, the consent of children who are competent to make decisions must be obtained for the decision. The concept of treatment refusal is referred to as the permanent disapproval of the proposed intervention to ensure the patient's well- being in the face of his/her reluctance. Children and Ethics There are specific ways to obtain informed consent from a child. Accordingly, the following should be noted: Lack of information forms written in a way that the child or his family can easily understand The concept of creating a written information form is new to simple practice. Simplifying the writing technique as well as the content Preference for colloquial language Having a form prepared in a conversational style Avoiding unnecessary technical language Avoiding long sentences Using active sentence structure instead of passive sentence structure. Children and Ethics In addition, In pediatric cases, it is an ethical responsibility for healthcare professionals, especially physicians and nurses, to be clearly aware of child abuse and neglect, to share the cases they encounter with the necessary authorities, and to play an active role in raising the awareness of the family and society. Conclusion Ethics has distinct roles in the field of children. This situation, which arises from the characteristics of pediatric patient groups, must be taken seriously. All members of the medical team must take into account the ethical protection of pediatric patients because they are vulnerable and open to abuse. Parents who have the authority to make decisions on behalf of their children also have certain obligations in this sense. Ultimately, parents should also play a supportive role in ensuring that the child participates in the doctor or nurse's wishes in the decision-making and approval process. It should not be forgotten that the child patient is an individual beyond certain characteristics and prioritizing his/her feelings and thoughts will guide the medical decisions to be made on his/her behalf. Ethics in the Elderly General Characteristics of Unethical Behavior Towards the Elderly 1982 Vienna → Old Age Independence Participation Care self realization Reputation AGE DISCRIMINATION Ethics in the Elderly The new position of the elderly individual in society, the discrimination and abuse he is exposed to → “Ageism” A healthy elderly person, who can continue his daily life and meet his own needs, can be thrown out of life by younger individuals by describing him as useless, incompetent, or senile, and the motivation and energy of the elderly person can be reduced. Ethics in the Elderly The pacified elderly individual, on the other hand, can be evaluated as an individual who eats readily and wastes limited resources. If we consider unethical behavior in terms of cognitive status, an elderly person who is mentally healthy and has good memory may be evaluated as having a weak memory or senile simply because of his age, and his attitudes and thoughts may be underestimated. Ethics in the Elderly On the other hand, an elderly person who has decreased cognitive abilities and is physically and mentally weakened may also be exposed to overprotectiveness and baby-like behavior. The protective attitude taken with the idea of helping the elderly without giving them the opportunity, with excessive compassion and emotional empathy, can lead to the physical and cognitive capacity of the elderly being further weakened due to not being used. In some cases, the elderly person may be financially abused by his relatives and a benefit may be expected. In particular, there may be behaviors such as forcing the elderly to share the inheritance and making the unfair sharing of the inheritance a bargaining issue in exchange for taking care of the elderly. Again, physical, verbal or sexual harassment and attacks that can be applied to the elderly are also examples of elder abuse.  In recent years, there is a widespread opinion that there is discrimination Ethics in the against elderly people in all areas where health care services are provided. Elderly Health personnel's own prejudices, values, perceptions and beliefs towards the elderly are considered to be among the main causes of ageism.  In the studies conducted, it has been determined that nurses prefer to work with younger age groups, they do not care or postpone the problems of elderly individuals as a natural Ethics in the course of life, and they perceive the elderly as dependent, inactive and isolated. In a study examining the positive and negative Elderly behaviors of acute care nurses towards elderly patients; It has been stated that nurses exhibit negative behaviors related to ageism, there is a lack of knowledge about elderly care, and the quality of care of the elderly is affected.  Urbanization and industrialization pose a major problem for the elderly, whose economic situation is not good. Ethics in the In this sense, with the industrialization, the contribution of the elderly to the society is almost negligible, and it may lead to the isolation of the Elderly elderly who are not in good economic condition from the society. Beliefs and attitudes towards the elderly and aging vary from culture to culture. Ethics in the Elderly While some societies attribute more negative qualities to old age (such as useless, worthless, weak, inadequate, etc.), in traditional societies such as Japan, the elderly are respected and benefit from their knowledge and experience. In Turkish culture, while respecting the elderly, respecting the words of the elderly and taking care of the elderly are traditional and unchangeable expectations, the status and prestige of the elderly in society is changing today. The factors that cause ageism to emerge are also discussed as follows; Fear of Death: Because death is kept out of the person's life cycle, and it is forgotten that it is a natural part of life. In fact, death and old age have been conceptualized as synonymous. Ageism, however, can be said to be a manifestation of the fears of the young and middle-aged about powerlessness, uselessness, disease, and death. The factors that cause ageism to emerge are also discussed as follows; Importance Given to Youth: Values and young images such as youth, dynamism, productivity and individuality are encouraged in every field, from politics to commercials, from education to management. The factors that cause ageism to emerge are also discussed as follows; Importance Given to Economic Efficiency and Productivity: Both the beginning and the end of the life cycle (children and the elderly) are years when there is no productivity and no contribution to production. Middle-aged people are considered to meet the needs and care needs of children and the elderly. Children are different from the elderly, they are considered an investment for the future. On the contrary, the elderly are seen as a burden because they leave their economic productivity behind. The factors that cause ageism to emerge are also discussed as follows; Research on the Elderly: This is due to the fact that most of the research on the elderly is conducted on the elderly in nursing homes, nursing homes or hospitals. Because these researches carried out in institutions caused the society to perceive the elderly as in need of constant care. Elderly Ethics in the Health System Some problems encountered in medical ethics in general also occur in the elderly. Especially when it comes to elderly patients, more complex and risky situations are encountered in solving these problems. For example, while more effort may be made to keep a young patient in intensive care alive, a similar effort may not be made for an elderly person. In particular, their guardians may request euthanasia. In this regard, it is necessary to mention some of the unethical behaviors that the elderly may encounter in the healthcare system. Euthanasia Euthanasia, in its most general definition; It is the intentional termination of a patient's life by a healthcare professional, at the patient's request and with full knowledge. Of course, if the patient is unconscious, this termination can be done with the consent of the guardians. It may also be possible that a legal statement was made in this direction by the elderly patient before the disease or when his cognitive functions were intact. However, if the patient's cognitive functions are insufficient and there is no prior declaration, then the legal guardian, relatives, physicians or ethics committees can have a say. Euthanasia The perspective on euthanasia may contain both legal and cultural differences. For example, the prohibition of suicide in the religion of Islam results in the prohibition of ending the life of a sick or unconscious patient. It is thought that treating the pain and suffering as much as possible, spending the last moments of life comfortably, and all the other troubles cause the patient to gain reward. Informed Consent An elderly person with good mental functions has the right to accept or reject all diagnostic tests, treatments and interventions to be applied to him/her. The elderly person should make a decision after being given adequate, unbiased information about the mentioned situations, being informed about the effects and side effects, and being presented with various treatment alternatives. Elderly people whose cognitive capacity is somewhat weakened still have the capacity and authority to make decisions about their health status and treatments. Informed Consent If the elderly person becomes unable to make decisions as a result of the progression of mental deterioration, a decision can be made by appointing a legal guardian, but this brings with it other problems. An overly protective or, on the contrary, indifferent guardian may not be able to make healthy decisions about the sick elderly person. In order to reduce such problems, the elderly individual can sign a written document stating the conditions and limits of intervention in his health while his cognitive capacity is still sufficient. In addition, being meticulous in appointing a guardian is a behavior in accordance with legal ethics. Unnecessary Treatments Another issue discussed within the scope of geriatric ethics is unnecessary and futile treatments. The healthcare provider needs an appropriate approach to interventions and treatments that do not contribute to the quality of life of an elderly person or an elderly person with severe dementia, cause financial personal or public burdens, cause the patient to become idle in hospital corners during various examinations and imaging methods, or increase their addiction. Unnecessary Treatments Based on the predicted life expectancy according to the health level of the elderly, the health personnel should do at every stage in order to protect the elderly from unnecessary examinations or heavy treatments; is to question the contribution or harm of the planned intervention or examination to the health of the elderly. Differences in appropriate decisions are expected between the ages of 50 and 80. In today's world where health budgets are being discussed more and imaging methods and interventions are diversified, the need for rational approaches that will use limited resources for the right purposes and at a level that will increase the quality of life of the elderly is increasing. Conclusion It should be taken into consideration that, like other segments of the society in need of protection, the elderly are among the social dynamics that keep the society alive. Being able to determine social, cultural and medical approaches that protect the rights of the elderly person, offer appropriate approaches without restricting their individuality and freedom, and do not isolate them from society is becoming more important day by day. Thanks Questions?