ACC - Alzheimers Caregiver Ethical and Legal Considerations Questions and Answers 1 — Questions and Answers
Question 1: A client with early-stage dementia has a valid Durable Power of Attorney for Health Care (DPOA-HC) naming her son as her agent. She currently has the capacity to make her own decisions. If she expresses a desire to refuse a specific medical treatment, what is the legally and ethically correct action?
- Consult the son (the DPOA-HC agent) and follow his decision on the treatment.
- Respect the client's decision, as she currently has decision-making capacity. (Correct answer)
- Proceed with the treatment because the DPOA-HC is in place for her protection.
- Petition the court for guardianship to override the client's refusal.
Correct answer: Respect the client's decision, as she currently has decision-making capacity.
A Durable Power of Attorney for Health Care only becomes active when the individual (the principal) is determined to be incapable of making their own healthcare decisions. As long as the person with dementia retains decision-making capacity, their own choices and preferences must be respected. The agent's authority does not override the principal's decisions while they still have capacity.
Question 2: You are a caregiver for Mr. Lee, who has moderate Alzheimer's. A friendly neighbor, who often helps with groceries, asks you for specific details about Mr. Lee's latest doctor's appointment and medication changes. According to the Health Insurance Portability and Accountability Act (HIPAA), what is the most appropriate response?
- Share the information, as the neighbor is part of the informal care team.
- Provide only general information, such as 'he's doing okay'.
- Explain that due to privacy laws, you cannot share his personal health information without his or his legal representative's explicit consent. (Correct answer)
- Tell the neighbor to ask Mr. Lee directly for the information.
Correct answer: Explain that due to privacy laws, you cannot share his personal health information without his or his legal representative's explicit consent.
HIPAA's Privacy Rule protects an individual's personal health information (PHI). Caregivers are bound by these rules and cannot disclose PHI to others, including well-meaning friends or neighbors, without the explicit consent of the patient or their legally authorized representative (such as a DPOA-HC). The most appropriate and legally compliant action is to decline to share the information, citing privacy regulations.
Question 3: Which of the following scenarios is a potential indicator of financial exploitation in a person with dementia that a caregiver should report?
- The client decides to hire a new weekly cleaning service.
- A family member helps the client pay bills and manage their checkbook.
- The client gives their adult child a small, customary birthday gift.
- Sudden, large withdrawals from bank accounts or unexplained changes to a will. (Correct answer)
Correct answer: Sudden, large withdrawals from bank accounts or unexplained changes to a will.
While the other options can be normal occurrences, sudden large financial transactions, missing money, or unexpected changes to legal documents like a will are significant red flags for financial exploitation or abuse. People with dementia are particularly vulnerable to such abuse, and caregivers are in a key position to notice and report these suspicious activities to Adult Protective Services or other authorities.
Question 4: A caregiver is caring for a client in the late stages of Alzheimer's who has a valid Do Not Resuscitate (DNR) order. The client stops breathing and has no pulse. What is the caregiver's primary legal and ethical responsibility?
- Call 911 and immediately begin performing CPR.
- Do not call 911, but make the client comfortable.
- Call 911, inform them of the DNR order, and provide comfort care. (Correct answer)
- Contact the client's family before taking any other action.
Correct answer: Call 911, inform them of the DNR order, and provide comfort care.
A DNR is a legally binding medical order. In the event of cardiac or respiratory arrest, the caregiver must honor it by not performing CPR. However, the caregiver still has a duty of care. The correct procedure is to call emergency services (911), clearly state that the person is unresponsive and has a DNR order, and follow the dispatcher's instructions while providing comfort and dignity to the client. The physical DNR order should be readily available for when emergency responders arrive.
Question 5: The ethical principle of 'autonomy' in dementia care refers to the:
- Caregiver's authority to make decisions that are best for the client.
- Fair distribution of care resources among all clients.
- Requirement to do no harm and protect the client from injury.
- Client's right to make their own choices and be involved in their care decisions, to the extent they are able. (Correct answer)
Correct answer: Client's right to make their own choices and be involved in their care decisions, to the extent they are able.
Autonomy is a core ethical principle that emphasizes respecting an individual's right to self-determination and to make decisions about their own life and healthcare. In dementia care, this means enabling the person to make choices for as long as they have the capacity and ensuring their previously expressed wishes are honored when they can no longer decide for themselves.
Question 6: A client with moderate dementia is deemed by their physician to no longer have the capacity to make complex medical decisions. Which legal document allows a pre-selected individual to make these decisions on the client's behalf?
- Standard Will
- Living Will
- Durable Power of Attorney for Health Care (Correct answer)
- Do Not Resuscitate (DNR) Order
Correct answer: Durable Power of Attorney for Health Care
A Durable Power of Attorney for Health Care (also called a healthcare proxy) is specifically designed to appoint an agent to make healthcare decisions for an individual once they are no longer capable of doing so. A living will states wishes for end-of-life care but doesn't appoint a decision-maker for other situations, a standard will deals with assets after death, and a DNR is a specific order about CPR.
ACC - Alzheimers Caregiver Ethical and Legal Considerations Questions and Answers 1
A client with early-stage dementia has a valid Durable Power of Attorney for Health Care (DPOA-HC) naming her son as her agent.
She currently has the capacity to make her own decisions.
If she expresses a desire to refuse a specific medical treatment, what is the legally and ethically correct action?