AAC Ethical & Legal Issues 3 — Questions and Answers
Question 1: A care facility staff member posts a photo of a resident with Alzheimer's on social media without consent. This violates which legal protection?
- The Americans with Disabilities Act
- HIPAA privacy regulations (Correct answer)
- The Older Americans Act
- The Fair Housing Act
Correct answer: HIPAA privacy regulations
Posting identifiable resident information without consent violates HIPAA privacy regulations protecting personal health information.
Question 2: What is the primary purpose of a guardianship order in the context of Alzheimer's care?
- To transfer property to family members
- To grant a court-appointed person legal authority to make decisions for an incapacitated individual (Correct answer)
- To establish a living will on behalf of the person
- To authorize involuntary psychiatric treatment
Correct answer: To grant a court-appointed person legal authority to make decisions for an incapacitated individual
Guardianship is a court-ordered legal arrangement giving a guardian authority over personal and/or financial decisions for an incapacitated person.
Question 3: When a person with advanced Alzheimer's has no advance directive and no family, who typically makes medical decisions?
- The primary care physician alone
- The state-appointed public guardian or ethics committee (Correct answer)
- The care facility administrator
- No decisions can be made without legal documentation
Correct answer: The state-appointed public guardian or ethics committee
In the absence of an advance directive or family surrogate, a public guardian or institutional ethics committee may be appointed by the court.
Question 4: An adult child tells care staff not to tell their parent with Alzheimer's about a terminal cancer diagnosis. What ethical concern does this raise?
- Beneficence, because protecting the parent from distress is the priority
- Non-maleficence, because truth could cause harm
- Autonomy, because the person may still have a right to know their diagnosis (Correct answer)
- Justice, because it violates equal treatment standards
Correct answer: Autonomy, because the person may still have a right to know their diagnosis
Even with cognitive impairment, the person's autonomy and right to information should be assessed based on their current decision-making capacity.
Question 5: Which scenario best illustrates the ethical principle of non-maleficence in Alzheimer's care?
- Providing aggressive treatment to prolong life at all costs
- Avoiding interventions that cause pain or distress with no clinical benefit (Correct answer)
- Ensuring all residents receive the same care regardless of diagnosis
- Respecting a resident's choice to refuse meals
Correct answer: Avoiding interventions that cause pain or distress with no clinical benefit
Non-maleficence means 'do no harm,' which includes avoiding burdensome treatments that offer no meaningful benefit.
Question 6: A care home uses physical restraints on a resident with Alzheimer's who wanders, without a physician's order or documented clinical justification. This practice violates:
- The Older Americans Act nutrition standards
- OBRA 1987 nursing home reform regulations (Correct answer)
- The Family and Medical Leave Act
- ADA reasonable accommodation requirements
Correct answer: OBRA 1987 nursing home reform regulations
OBRA 1987 mandates that restraint use in nursing facilities requires physician orders, clinical justification, and the least-restrictive approach.
Question 7: A healthcare proxy is making decisions that appear to conflict with what the person with Alzheimer's previously expressed when competent. The care team should:
- Defer entirely to the proxy since they have legal authority
- Review any documented advance directives and facilitate an ethics consultation (Correct answer)
- Override the proxy and follow the prior verbal wishes
- Discharge the patient to avoid the conflict
Correct answer: Review any documented advance directives and facilitate an ethics consultation
When proxy decisions conflict with prior expressed wishes, reviewing advance directives and engaging an ethics committee ensures decisions align with the person's values.
AAC Ethical & Legal Issues 3
A care facility staff member posts a photo of a resident with Alzheimer's on social media without consent.
This violates which legal protection?