ACC Legal and Ethical Considerations 3 — Questions and Answers
Question 1: A newly diagnosed Alzheimer's patient refuses to stop driving despite safety concerns. What is the most appropriate first ethical and legal step?
- Immediately disable the vehicle without telling the patient
- Notify local law enforcement to revoke the license
- Consult with the physician who may report to the DMV and have a direct conversation with the patient (Correct answer)
- Allow the patient to continue driving as their autonomy is paramount
Correct answer: Consult with the physician who may report to the DMV and have a direct conversation with the patient
The physician can report unsafe drivers to the DMV in many states, and an honest conversation with the patient about safety risks respects dignity while addressing the legal and public safety concern.
Question 2: Guardianship differs from power of attorney for an Alzheimer's patient primarily because:
- Guardianship is self-appointed while power of attorney requires a court
- Guardianship is court-ordered and revokes the individual's legal rights, while POA is voluntarily granted (Correct answer)
- Power of attorney covers more decisions than guardianship
- Guardianship applies only to financial matters
Correct answer: Guardianship is court-ordered and revokes the individual's legal rights, while POA is voluntarily granted
Guardianship is a court process that legally removes decision-making rights from the individual, whereas power of attorney is a voluntary legal document the person grants while still competent.
Question 3: A caregiver who is also a mandatory reporter suspects an Alzheimer's patient is being physically abused by another family member. What is the required action?
- Investigate thoroughly before making any report
- Confront the suspected abuser directly first
- Report the suspicion to Adult Protective Services even without confirmed proof (Correct answer)
- Document the situation and wait for a second incident to confirm the pattern
Correct answer: Report the suspicion to Adult Protective Services even without confirmed proof
Mandatory reporters are legally required to report reasonable suspicion of abuse to APS; they do not need to confirm or investigate the abuse themselves before reporting.
Question 4: Which ethical principle is MOST at stake when a caregiver withholds an Alzheimer's diagnosis from the patient at the family's request?
- Justice
- Non-maleficence
- Autonomy and truth-telling (Correct answer)
- Beneficence
Correct answer: Autonomy and truth-telling
Withholding a diagnosis from a patient undermines their autonomy and the ethical obligation of truth-telling, as patients generally have the right to know their own diagnosis.
Question 5: A POLST (Physician Orders for Life-Sustaining Treatment) form differs from an advance directive in that it:
- Is written by the patient alone without medical input
- Only applies to patients under age 65
- Is a medical order immediately actionable by first responders (Correct answer)
- Must be reviewed by a court before implementation
Correct answer: Is a medical order immediately actionable by first responders
A POLST is a physician-signed medical order that is immediately actionable by first responders and care staff, unlike an advance directive which is a legal document expressing patient preferences.
Question 6: An Alzheimer's patient's family asks the caregiver to use physical restraints to prevent wandering at home. The caregiver should:
- Apply restraints as the family has legal authority over care decisions
- Comply only if a physician order is obtained
- Refuse, as physical restraints can cause harm, and suggest safer alternatives like door alarms (Correct answer)
- Report the family to authorities for requesting restraints
Correct answer: Refuse, as physical restraints can cause harm, and suggest safer alternatives like door alarms
Physical restraints carry serious risks including injury, increased agitation, and death, and caregivers should advocate for evidence-based alternatives such as environmental modifications and monitoring devices.
Question 7: When an Alzheimer's patient in late-stage disease who has no advance directive needs emergency surgery, who has the legal authority to provide informed consent?
- The attending surgeon based on medical necessity alone
- The court-appointed guardian or next of kin following state hierarchy laws (Correct answer)
- Any registered staff nurse present at the time
- The institution's ethics committee exclusively
Correct answer: The court-appointed guardian or next of kin following state hierarchy laws
When no advance directive exists, consent falls to a court-appointed guardian or, per each state's surrogate decision-making hierarchy, typically the next of kin in a defined priority order.
ACC Legal and Ethical Considerations 3
A newly diagnosed Alzheimer's patient refuses to stop driving despite safety concerns.
What is the most appropriate first ethical and legal step?