Family & Caregivers

Ethical Issues

Dealing with Ethical Issues
Ethics refer to the moral aspects of human conduct and personal character. Often ethical dilemmas arise in relation to personal freedoms, responsibilities, and rights or obligations. To help older adults and their loved ones work through ethical dilemmas, the Aging Institute of UPMC Senior Services and the University of Pittsburgh, in partnership with the University of Pittsburgh Center for Bioethics, identifies and offers insight into some common situations in which ethical issues may arise, such as:

Advance Care Planning: Advance care planning involves advance preparation for life’s unexpected emergencies. Regardless of age, advance care planning provides greater control over decisions that affect a person’s future and takes into consideration a person’s beliefs and preferences in the event they are unable to make decisions on their own.
Health Care: Health care ethics, often referred to as “medical ethics,” relate to issues of privacy, confidentiality, and informed consent as well as the courses of action involved in making medical decisions.
Family and Friends: Whether a person is very close with his or her family or has not spoken with them in years, family members often become involved in the care of a sick family member. A patient may be uncomfortable talking with family about his or her care and treatment preferences, or the patient may not want their medical information to be shared with family or friends.
Right to Privacy: Medical treatment often involves sensitive subjects that we would rather not share with other people — even those who are very close to us. If your loved one is receiving treatment, and does not want information shared with family, friends, or anyone else, he or she should know that knowledge is kept private between a patient and his or her health care team.
Religion and Health Care: Religion may be a very important part of your loved one’s life. If so, his or her religious beliefs may influence the types of medical treatment he or she desires. It is crucial to know a religion’s true beliefs about certain medical procedures. Many times, even the most devout people are unclear about some of their religion’s rules. They may refuse medical treatment that is allowed by their faith or consent to medical treatment that is not permitted.

FAQs About Ethical Issues

Following are some frequently asked questions and answers about common ethical issues:

Q: My loved one is afraid he won’t get the treatment he wants or will receive treatment he doesn’t want when he can no longer make medical decisions for himself. How can I make sure his wishes are followed?

Plan ahead for life’s unexpected emergencies:

Discuss with your doctor, family members, and friends, different medical scenarios that might arise, and help them to understand your preferences for treatment and medical care. Share with them both your preferences and values.
Explain your preferences in writing. Complete an advance directive – a living will or a durable power of attorney for health care. Give copies to your doctor, local hospital, and family members or friends.

A living will is a document that specifies what you want and do not want if you are in a certain condition, such as a persistent vegetative state, for example. A medical power of attorney (also known as a “durable power of attorney for health care”) is a document that appoints someone you trust to make health care decisions for you when you are not able to do so.

Q: What should I do if my loved one has an ethical issue of conflict in the course of medical care, home care, or long-term care?

The best ways to resolve ethical conflicts are to:

Discuss the issue of concern with the people involved: doctors, nurses, social workers, family.
Request a meeting to develop a plan on which everyone can agree.
Ask for an ethics consult (a meeting with the ethics committee).

An ethics consult is a meeting between a patient, family member, or a member of the health care team and an established committee of ethical consultants to discuss ethical issues.

At most hospitals and long-term care facilities, ethics committees are comprised of individuals with both experience in the clinical care environment and in resolving ethical issues that arise in the facility. These individuals understand both hospital policies and patient rights. They help to clarify issues and make recommendations.

Q: My loved one’s doctor is recommending a medical procedure, but she’s not sure she wants to go ahead with it. Does she have a right to more information?
Yes, she has the right to all the information that is needed to make a sound and informed decision. If she has questions, it is a good idea for her to write them down and discuss them with the doctor.

Q: When a patient and his or her family disagree about medical treatment, whose preferences determine the patient’s care?
So long as patients are capable of making decisions on their own, they have the right to make all of the decisions regarding their medical treatment. Of course, the best way to avoid difference in opinion when care is needed is for patients to discuss their preferences with their family and doctor in advance.

Q: Does my loved one have the right to refuse treatment?
Yes. As the patient, your loved one has the right to refuse any course of treatment he or she does not want or with which he or she is not comfortable. However, your loved one may want to obtain a second opinion from a different doctor before deciding to refuse the suggested course of care.
If your loved one is afraid that in the future he or she will be unable to speak for him or herself to direct the course of treatment, your loved one should plan ahead. Tell him or her to talk with the doctor and your family about the types of treatment(s) he or she does or does not want.

He or she may also sign an advance directive (a document that outlines what type of treatment he or she wants or does not want) or designate a surrogate decision maker (a person your loved one trusts to make decisions for him or her, based on what he or she would want, in the event he or she cannot make those decisions).

Q: What does it mean to have informed consent? Why is it important?
Patients face decisions about their health care that require their consent or refusal. A doctor is obligated by law to fully inform the patient of his or her condition, treatment options, and the benefits and consequences of those options, so that the patient has the knowledge to allow for informed choice.

In a good doctor-patient relationship, the patient and doctor decide together on the desired course of treatment. Informed consent means that a person agrees to a course of treatment based on the information provided by the physician or another member of the health care team. By ensuring that the patient is aware of the advantages and disadvantages of the various treatment options, he or she is able to participate fully in health care decisions.

If your loved one feels he or she does not have enough information to make a decision, he or she should ask questions about the options. If your loved one is not comfortable asking the doctor or is not satisfied that the doctor has provided enough information, he or she should talk to another health care professional with whom he or she feels comfortable talking, like the nurse.

Q: What is decisional capacity?
Decisional capacity is the understanding needed to make a particular decision. Health care patients have decisional capacity when they are able to understand risks, benefits, and treatment options, and are able to think about and decide what to do in a particular situation.

Q: My loved one is getting older and frailer, and some difficult decisions about care will have to be made in the near future. Who can help me sort through the options?
Each individual and family is unique and must find the most appropriate balance to suit their situation and needs. Advance planning can help. Talk with everyone involved: your family, religious advisor, doctor, nurse, and social worker.

Q: My loved one does not want my family to be informed about his health condition. What can he do to make sure his wishes are followed?
He should inform his doctor and hospital of his wishes to prevent them from assuming he wants your family to be informed. He should ask them not to share any details about his condition with anyone without his permission.

Q: If a patient does not have family living near him, or he is not close to anyone in his family, can a close friend or significant other make decisions for him, if he cannot make them himself?<
Yes. To identify a friend as a decision maker, a person would need to complete a durable power of attorney for health care. This document, officially recognized by health care facilities, allows whomever you designate to make decisions regarding your care when you are no longer able to decide for yourself.

Q: My loved one wants to make sure her family and religious community are informed about her health. What should she do?
Request from her doctor or hospital a form on which she may identify the people whom she would like to receive information about her condition. Also, if she would like her name mentioned in the congregational announcement for prayers, she should inform the minister of her religious community.

Q: Why is privacy important?
Privacy is important because medical information is often very personal and sensitive. Sharing a person’s medical information may not only affect how other people think of them, but it may influence their insurance coverage, employment, and benefits.

Q: What is confidentiality and why is it important?
Hospitals and health care professionals are obligated to protect a patient’s privacy. They are required to keep all health care information about a patient confidential, unless they are required by law to share it or the patient gives permission for information to be shared.

Q: What is HIPAA?
HIPAA stands for the Health Insurance Portability and Accountability Act. This law identifies the privacy rules that hospitals must follow to ensure the protection of your privacy and health information. Visit UPMC’s website to see a sample of a Notice of Privacy Practices.

Q: My loved one’s doctor is recommending a procedure that is forbidden by his religious beliefs. Is there someone who can help him make a decision about treatment?
As people sometimes misunderstand the beliefs of their religion with regards to allowed and disallowed medical treatments, your loved one should discuss his situation with a religious advisor and his doctor to clarify exactly what is allowed and forbidden. He may also want to consult with his religious community or religious guidebooks.

Q: Can my loved one request that his treatment be adjusted to conform to his religious beliefs?
Any person of sound mind has the right to refuse treatment that goes against his or her religious beliefs. Your loved one may also request that his medical treatment be tailored to comply with his religious beliefs. For example, some doctors may be able to perform a procedure without the use of blood or blood product, or may offer alternatives to comply with religious beliefs that prohibit their use.

Just as the patient has the right to refuse treatment, doctors maintain the right to refuse to perform procedures that they believe place the patient at risk or do not comply with medical standards.

Q: Is there someone in the hospital who can help meet my loved one’s spiritual needs during her stay?
All hospitals provide access to chaplains who minister to the spiritual needs of patients and their family members upon request. Although most hospital chaplains are trained to help people of all faiths, you may wish to inform them of the faith-based community to which your loved one belongs.

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