BCG Professional Ethics & Standards 3 — Questions and Answers
Question 1: A gerontological nurse practitioner is asked by a family to withhold a terminal diagnosis from their 80-year-old mother 'to protect her.' Ethically, the practitioner should:
- Honor the family's wishes to maintain trust
- Disclose the diagnosis to the patient, who has decisional capacity, unless she explicitly requests otherwise (Correct answer)
- Delay disclosure until the family agrees
- Refer all communication to the attending physician
Correct answer: Disclose the diagnosis to the patient, who has decisional capacity, unless she explicitly requests otherwise
A capacitated patient has the right to truthful information about her own health, and therapeutic deception is an ethical violation.
Question 2: Which document legally designates a trusted person to make healthcare decisions for an incapacitated older adult?
- Living will
- Do Not Resuscitate order
- Durable power of attorney for healthcare (Correct answer)
- Advance beneficiary notice
Correct answer: Durable power of attorney for healthcare
A durable power of attorney for healthcare (healthcare proxy) appoints a surrogate decision-maker when a person loses decisional capacity.
Question 3: Elder mistreatment reporting laws in the United States are BEST characterized as:
- Uniform federal mandates that apply identically in all states
- State-specific statutes that vary in definitions, mandatory reporters, and procedures (Correct answer)
- Voluntary guidelines without legal enforcement
- Applicable only to residents of licensed care facilities
Correct answer: State-specific statutes that vary in definitions, mandatory reporters, and procedures
Adult Protective Services laws are enacted at the state level and differ significantly in scope, definitions, and mandatory reporter designations.
Question 4: The ethical concept of 'substituted judgment' in surrogate decision-making requires the surrogate to:
- Make the decision they personally believe is best for the patient
- Choose the least expensive treatment option available
- Base decisions on what the incapacitated person would have wanted (Correct answer)
- Follow the recommendations of the treating physician exclusively
Correct answer: Base decisions on what the incapacitated person would have wanted
Substituted judgment asks the surrogate to step into the patient's shoes and honor the patient's own values and prior expressed wishes.
Question 5: A gerontological care manager realizes she has a personal financial interest in a home care agency she is recommending to clients. This situation represents:
- Acceptable practice if the agency provides quality care
- A conflict of interest requiring disclosure and possibly recusal (Correct answer)
- A minor administrative issue with no ethical implications
- Standard referral practice in gerontological care management
Correct answer: A conflict of interest requiring disclosure and possibly recusal
Financial interests in referral recipients create conflicts of interest that must be disclosed to clients and may require the professional to refrain from making the referral.
Question 6: Which federal law establishes minimum standards for nursing facility residents' rights, including dignity, self-determination, and grievance procedures?
- Americans with Disabilities Act (ADA)
- Older Americans Act (OAA)
- Omnibus Budget Reconciliation Act (OBRA) of 1987 (Correct answer)
- Health Insurance Portability and Accountability Act (HIPAA)
Correct answer: Omnibus Budget Reconciliation Act (OBRA) of 1987
OBRA 1987 created the Nursing Home Reform Act, establishing enforceable residents' rights in certified nursing facilities.
Question 7: When a gerontological professional suspects self-neglect in a community-dwelling older adult who refuses services, the FIRST ethical consideration is:
- Immediately petition for guardianship to ensure safety
- Assess decision-making capacity and respect autonomous refusal if capacity is intact (Correct answer)
- Remove the client from the home environment for evaluation
- Notify law enforcement to conduct a welfare check
Correct answer: Assess decision-making capacity and respect autonomous refusal if capacity is intact
A competent adult's right to refuse services—even when choices appear harmful—must be respected unless capacity is impaired.
BCG Professional Ethics & Standards 3
A gerontological nurse practitioner is asked by a family to withhold a terminal diagnosis from their 80-year-old mother 'to protect her.' Ethically, the practitioner should: