have a perspective of their own best
Ethical Considerations in the Care of interests, shaped by their values and
Older Adult beliefs developed over a lifetime,
that defines each individual as a unique
What is Ethics in Geriatric Care? person.
- If a patient lacks the capacity for
● For the elderly, ethics is about such a decision and has an advance
how they want to be treated and directive, the person who has the
allowed to make their own durable power of attorney can make the
decisions. decision.
● For family members as - Paternalism occurs when the
caregivers, ethics is about doing nurse does not respect the patient’s
what is right even when no one is right to autonomy by acting as if he or
looking. she knows what is best for the patient,
● For professionals providing rather than the patient (Silva & Ludwick,
eldercare, ethics is about 1999).
adherence to established canons - Paternalism disempowers the
of ethics promulgated by patient
organizations. - Informed consent involves the
patient’s right to autonomy and
self-determination
Key Ethical Principles in the Care of
Older Adults
Three Elements of Informed Consent
1. The right to quality health care.
Informed - sufficient information
- means that they have adequate
must be provided
access to quality care.
Competent - involves the capacity to
- they have a right to the same high
weigh out the potential benefits in
standards of health care as those in any
comparison to the risks by applying
age group
“rational reason”
Voluntary - the patient is not coerced
2. Respect for the individual person. into participation and that consent can
- Kant explicates this fundamental be withdrawn at any time
principle in ethics as follows :
4. Privacy and Confidentiality
- “So act that you treat humanity in
- Involves sharing only patient
your own person and in the person of
information on a need-to-know basis.
everyone else, as an end and never
- There may also be instances
merely as a means“
when a clinician may be obligated to
override the duty to maintain
3. Autonomy or Self – determination confidentiality
- Respecting the principle of
autonomy means that older patients will
5. Beneficence
be respected as decision-makers about
- The principle of beneficence or
their own care.
“doing good “ means that the highest
- All competent older persons
good will be done for older people in a ● Between rights of patients and
particular situation. nurses’ responsibilities to those
patients actual conflicts of
interest arising when family
6. Nonmaleficence members and professional
- Do no harm caregivers assist or represent the
- Concept originated from the elderly
Hippocratic Oath
- Applied to nursing by not
causing injury, whether it be a physical, Measures to Help Nurses Make
psychological, emotional, or financial Ethical Decisions
injury to patients (Silva & Ludwick,
1999) 1. Encourage patients to express
their desires.
2. Identify significant others who
6. Justice impact and are impacted.
- Right to be treated equally, and 3. Know thyself.
in some cases equal access to 4. Read.
treatment and allocation of 5. Discuss.
resources 6. Consult
7. Share
8. Form an Ethics Committee
7. Veracity 9. Evaluate Decisions
- truthfulness
- Principle of veracity also Philippine Laws related to Care of the
compels that the truth is completely told. Older Persons
- Quality of the relationship 1987 Philippine Constitution, Art. XV,
between nurse & patient is based on sec. 4
trust & integrity
● It is the duty of the family to take
care of its older members while
8. Fidelity the state may design programs of
- It involves an agreement to keep our social security for them.
promises. Fidelity refers to the concept
of keeping a commitment and is based RA 7432 “Senior Citizens Act of 1992
upon the virtue of caring.
- means to respect our words and ● An act to maximize the
duty to elder patients contribution of senior citizens to
nation-building, grant benefits &
What is an ethical dilemma? special privileges & for other
purposes.
Situations that produce conflicts:
RA 9257 “Senior Citizens Act of
● Between nurses’ values and 2003”
external systems affecting their
decisions ● Granted 20% discount on food
and beverages, medical, dental,
transportation, etc.
RA 9994 “Expanded Senior Citizens and medical needs, and call emergency
Act of 2010” services in times of crisis.
● Amended the previous laws There is no doubt that carebots will play
granting senior citizens additional
a necessary role in any future of
privileges and benefits.
caregiving, yet it is important to pause
Carebots: A Potential Solution to here and state a few normative claims
Elderly Care regarding that use.
To address this caregiving crisis and fill First, carebots are not an equivalent
the caregiving void, technologists and replacement of human care. They may
caregivers are turning to robotics and perform some tasks more efficiently, or
Artificial Intelligence (AI). Japan, whose reduce difficult burdens of informal
Gray Wave is cresting now, leads the caregivers, but ensuring that humans
world in the adoption of caregiving continue to care for humans in some
robots, typically called carebots. capacity is paramount.
The most common carebots in Japan Children who were raised by their
and worldwide are robotic companion parents have a moral obligation of
“animals.” These companion reciprocity to care for them in
animal-shaped carebots keep older
adults company and engaged by Ethical Considerations:
interacting with them and responding to
1. Do good and minimize harm. This
physical and audio ques with
is a basic moral obligation in
appropriate movements and sounds.
healthcare, and it applies even
Paro, a highly popular companion
more in the older adult care
carebot “seal,” has demonstrated that it
context. Why? Because more so
decreases older adults’ loneliness, and
than younger adults, older adults
anecdotally makes older adults more
face more critical and numerous
calm, talkative, and sociable.
healthcare decisions.
“Carebots are not equivalent 2. The intention behind using a
replacements of human care” carebot should be to serve older
adults’ best interest. Their
Carebots have many uses. Robear, for primary charge is to improve
example, is a large bear-like robot which care, all else should be
can move older adults into and out of secondary.
bed, the bath, and other hard to reach 3. Older adult care belongs to a
positions. Further, startups like special, protected, class. Many
CareCoach build and sell AI-enabled older adults are more vulnerable
virtual assistants to engage with older and fragile than the general
adults, keep tabs on their movements population and thus should be
treated with greater respect and
care.
4. Act to preserve older adult’s
autonomy and agency. As older
adults age, some tend to
experience reductions in their
autonomy and agency. It is
crucial that carebots don’t reduce
them further.
5. Manipulation is never morally
justified. Using an older adult as
a mere means to achieve one’s
own ends is a definitive moral
wrong.
6. Deception may lead to feelings of
betrayal and distrust. Deception
is a risky tool; when it is used too
liberally it can create
compounding negative
consequences.
7. Deception should be the last
resort. It is always morally
preferable to rely on another form
of response, for example,
avoiding the question or
redirecting the conversation.