ACC Legal and Ethical Considerations 2 — Questions and Answers
Question 1: A person with mild Alzheimer's disease wants to update their will. What is the legal standard that determines if they can do so?
- They must have no cognitive impairment whatsoever
- They must demonstrate testamentary capacity at the time of signing (Correct answer)
- A physician must certify them competent one week before signing
- They must pass a standardized cognitive screening test
Correct answer: They must demonstrate testamentary capacity at the time of signing
Testamentary capacity requires the person to understand what a will is, know their property, recognize their heirs, and understand how the document distributes assets at the specific time of signing.
Question 2: A caregiver discovers that an Alzheimer's patient's adult child is withdrawing large sums from the patient's bank account without authorization. This is best classified as:
- A family financial matter outside caregiver jurisdiction
- Financial exploitation of a vulnerable adult (Correct answer)
- Legal estate planning activity
- A permissible power of attorney transaction
Correct answer: Financial exploitation of a vulnerable adult
Unauthorized withdrawal of funds from a vulnerable adult's account constitutes financial exploitation, which is a form of elder abuse reportable to Adult Protective Services.
Question 3: Which document specifically allows a designated person to make medical decisions on behalf of an Alzheimer's patient who lacks decision-making capacity?
- Living will
- Healthcare proxy (durable power of attorney for healthcare) (Correct answer)
- Do Not Resuscitate order
- POLST form
Correct answer: Healthcare proxy (durable power of attorney for healthcare)
A healthcare proxy or durable power of attorney for healthcare designates a specific agent to make medical decisions when the patient can no longer do so.
Question 4: An Alzheimer's patient in a care facility repeatedly asks to go home and attempts to leave. The facility uses a locked door code system. This practice is ethically justified primarily because:
- It eliminates all caregiver supervision responsibilities
- It balances safety from wandering risk against restrictive freedom (Correct answer)
- It is required by all state laws for dementia facilities
- It prevents family members from visiting unannounced
Correct answer: It balances safety from wandering risk against restrictive freedom
Secured environments represent an ethical balance between protecting cognitively impaired individuals from wandering dangers and minimizing unnecessary restriction of freedom.
Question 5: When an Alzheimer's patient's previously documented advance directive conflicts with what their healthcare proxy now requests, which generally takes precedence?
- The healthcare proxy's current request always overrides the advance directive
- The advance directive, as it reflects the patient's own prior wishes (Correct answer)
- The attending physician's independent clinical judgment
- The most recent verbal statement made by the patient
Correct answer: The advance directive, as it reflects the patient's own prior wishes
Advance directives represent the patient's own self-determined wishes and generally take precedence over proxy decisions, as the proxy's role is to honor those stated wishes.
Question 6: A caregiver uses a therapeutic fiblet, telling an Alzheimer's patient that their deceased spouse 'is at the store' to prevent distress. The main ethical concern with this approach is:
- It constitutes criminal fraud and is always prohibited
- It involves deception, which conflicts with the principle of honesty but may serve beneficence (Correct answer)
- It is fully ethical and carries no moral considerations
- It requires written physician authorization before use
Correct answer: It involves deception, which conflicts with the principle of honesty but may serve beneficence
Therapeutic fiblets create an ethical tension between truthfulness (non-deception) and beneficence (preventing unnecessary suffering), requiring case-by-case judgment.
Question 7: Under HIPAA, which of the following parties may a caregiver share an Alzheimer's patient's protected health information with, without specific written authorization?
- Any curious family member who asks
- Media representatives covering dementia awareness
- The patient's designated healthcare proxy for treatment decisions (Correct answer)
- Employers conducting workplace health screenings
Correct answer: The patient's designated healthcare proxy for treatment decisions
HIPAA permits sharing protected health information with a legally designated healthcare proxy for treatment-related purposes without additional written authorization.
ACC Legal and Ethical Considerations 2
A person with mild Alzheimer's disease wants to update their will.
What is the legal standard that determines if they can do so?