According to the National Council on Aging, about one in 10 Americans aged 60 or older have suffered from at least one of the 7 forms of elder abuse identified by the National Center on Elder Abuse (NCEA)” (Nursinghomeabusecenter.com, 2020, para.1). Elderly patients require help as they continue to age in their lifetime but unfortunately for some, abuse happens. Elder abuse can happen anywhere not just in nursing homes. Elders that are most likely to suffer from abuse tend to be women, but men can be victims of abuse as well. The victims of elder abuse usually are patients with mental illnesses like dementia or those that are far from loved ones and families. When considering the ethical dilemmas that surround euthanasia, suicide and assisted suicide my approach is to be open minded and aware of how the subject can be sensitive to the majority of patients and their families. Euthanasia, suicide and assisted suicide are topics that are hard to discuss for many, but as nurses we must often encounter this in our profession. Having the right type of information about these topics will help to approach these subjects in an efficient manner that will be comforting to patients and their families.
The National Center on Elder Abuse identified seven different types of abuse that happens to elders. The types of abuse are; physical abuse, sexual abuse, emotional abuse, financial and material exploitation, neglect, abandonment, and self-neglect. With elder abuse the definition of physical abuse is an action of physical force that results in bodily harm, physical pain or impairment. Sexual abuse is defined as sexual contact of any kind without consent from the elder. Emotional abuse is defined as directly causing pain, anguish, or distress to an elderly person whether its verbal or non-verbal. Financial and material exploitation is when an elder’s financial funds, assets or properties are taken advantage of illegally or improperly. Neglect happens when a person refuses or fails to attend to an elderly person needs and obligations. Abandonment is when the person who has legal custody and or responsibility of an elderly person decides to desert them. Self-neglect happens when an elder behaves in a manner that can cause direct harm to their health or safety.
Being face with the controversial topics of euthanasia, physician assisted suicide and suicide can be a difficult task, however it needs to be addressed properly and in a professional manner. As nurses, we attend to patients who may have attempted to commit suicide or are severely ill and are considering euthanasia or physician assisted suicide. The dilemmas that might arise from these topics tend to against euthanasia, physician assisted suicide and suicide because ultimately a life is ending. With physician assisted suicide and euthanasia many people believe that the physician is going against their code of ethics as a healer by allowing a patient to commit suicide. However, the intention behind this type of procedure, is to end pain and suffering. The approach I would take ideally would be to provide information like educate a patient and reorient them into a positive manner of thinking and provide as much emotional support as needed. The patient with this type of ideation is suffering and is only looking to feel better. Educating the patient might give them the right insight they need to re-evaluate their situation and reconsider euthanasia, or physician assisted suicide. “With the ever-expanding ability to both prolong and end life, nurses must not only remain cognizant but also prepared for any and all repercussions associated with life and death situations” (Llamas, 2018, para. 6). Nurses will usually be involved with euthanasia, physician assisted suicide and suicide as they are treating a patient, however, the way the nurse handles the ethical issues that may arise compliments the many abilities of the nurse to help those in need.
Post # 2 Elder Abuse
Elder Abuse, Euthanasia, and Assisted Suicide
Abuse is often associated with visual markings; bruises, broken bones, wounds, broken glasses, to name a few. It is most frequently inflicted on vulnerable individuals, most notably children and the elderly. A lack of standardized research and underreporting leads to a lack of information about elder abuse. It is understood to be a single or repeated act that occurs within a relationship where trust is expected which causes distress or harm to an elderly person (Ryan & Roman, 2019). The trust relationship that is usually violated frequently involves family members and they are deemed to be the most likely perpetrators of elder abuse.
Types of Elder Abuse
According to the research, approximately 2 million elders in the United States are abused. The National Center on Elder Abuse (NCEA) was established in 1988 as a national elder abuse resource center. It provides research information, training, news, best practices to professionals and to the public. In addition to research, NCEA also educates and creates policy (Ncea – Home, n.d.). Physical abuse is more readily identified as they result in bodily injury; bruises, black eyes, welts, broken bones. These injuries can be caused by using physical force such as hitting, pushing, or inflicting physical punishment. There are other types that have equally devastating consequences and can lead to emotional suffering and even death. Sexual abuse: non-consensual contact of any kind with an elderly person; demonstrated by bruises around breasts or genitals, newly diagnosed sexual diseases, unexplained vaginal or anal bleeding. Emotional/psychological abuse: inflicting emotional distress by using verbal or non-verbal acts; often demonstrated by agitation, withdrawal, or showing signs of dementia. Neglect: failure to provide necessary care or fulfill obligations/duties towards an elderly person; not providing food, shelter, clothing, and untreated health problems. Abandonment: desertion by an individual who has assumed care for an elder; leaving an individual at a hospital, shopping center public location. Financial exploitation: improperly using funds, assets, or property; sudden transfer of assets to previously uninvolved family members, withdrawal of funds using ATM cards. Self-neglect: the behavior of an elderly person that threatens their health or safety; failure to provide food. hygiene, medication (Ncea – Abuse Types, n.d.). Financial abuse by a family member ranks among the highest alleged form of abuse at 67% (Goodman et al., 2018). The writings of Ryan & Roman (2019) show that taking a family-centered intervention has been shown to decrease elder abuse due to its holistic approach of recognizing that the elderly are important in the community and family. Taking this approach can negate the fear of speaking up against elder abuse.
Ethical Dilemmas regarding Euthanasia and Assisted Suicide
Death is an inevitable part of life. It comes unexpectedly and at times at the end of an illness. The advancement of technology makes it possible to prolong natural life. Because terminally ill patients and families make choices regarding their preferred treatment, medical caretakers must be knowledgeable about end of life issues. Euthanasia is a term used to describe an intentional, active act of painlessly putting to death a person suffering from an incurable medical condition at that person’s explicit request. Several countries have adopted assistance in dying and offer some type of euthanasia such as Canada, the Netherlands, Belgium, Columbia, and some US states. In other countries like Switzerland, Luxembourg, certain procedures that aid in dying are allowable under some predetermined circumstances (Pesut et al., 2019). Arguments have been made for and against Medical assistance in dying. The word compassion has been used both for and against euthanasia. Those against euthanasia argued about safeguarding the sanctity of life and acting with compassion. Those who argue for it want to relieve pain and suffering with compassion. Legalizing assisted suicide has presented nurses with ethical and moral decisions about their involvement in the process. Some feel strongly against assistance in dying and at the end of that spectrum is full conscientious objection; those nurses are relieved of involvement at all stages of care in order to preserve their moral integrity. Those nurses should inform their employers of their conscientious objections at the start of their employment contract. It may be helpful to think of supporting the patient and evaluating the payback rather than the intervention itself. Medicating a patient for pain and suffering may hasten death; the dilemma for the medical caregiver is initiating the treatment that relieves the pain may decrease the patient’s respiration and cause his death.
There is no right or wrong answer. The nurse must be introspective and evaluate their own belief system, respect that of the patient, and practice with moral integrity
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