GERIATRICS - End of Life Ethics
Rehabilitation for patients who are approaching their end of life poses complex clinical, ethical, and legal challenges for physical therapists (PTs) and physical therapist assistants (PTAs). The most serious of these challenges may include participation in difficult end-of-life decisions related to initiating or continuing life support and withholding or withdrawing medical treatment. Although therapists are not typically the primary healthcare professionals involved in making these decisions, they are part of the professional healthcare team, and have an obligation to support the patient, family, and healthcare professionals when patients are faced with making these decisions.
Editor: Barbara Billek-Sawhney, PT, EdD, DPT, GCS
Upon completion of this monograph, the course participant will be able to:
1. identify major legal and ethical issues in providing end-of-life care.
2. describe major milestones that facilitated changes in the provision of end-of-life care in the us.
3. explain the significance and implications in the use of advance directives.
4. describe the role and authority of surrogates in end-of-life decision-making.
5. define the difference between substituted judgment and best interest standard used by surrogate decision-makers and discuss the implications of each standard.
6. differentiate competence from capacity.
7. explain and differentiate the purpose of hospice and palliative care.
8. discuss ethical concerns in end-of-life care provided in nursing homes.
9. discuss the effectiveness of codes of ethics in guiding decision-making for therapists.
10. integrate concepts of various ethical theories to end-of-life care.
11. describe the impact of religion and spirituality on end-of-life care.
Mary Ann Wharton
Ms. Wharton is currently an independent Physical Therapy Consultant and holds adjunct faculty positions in the University of Pittsburgh Medical Center (UPMC) Geriatric Residency program and in the PTA program at Allegheny County Community College, Boyce Campus, Monroeville, PA. Previously, she served as faculty in Physical Therapy programs at Saint Francis University, Slippery Rock University, and the University of Pittsburgh. She is a physical therapy graduate of Ithaca College, and received a Master of Science degree in Leadership, with an emphasis in Geriatric Physical Therapy from the University of Pittsburgh. She is currently the Chair of the Pennsylvania Physical Therapy Association’s(PPTA) Ethics Committee; Chair of the PPTA Geriatric Special Interest Group; Public Liaison for the Academy of Geriatric Physical Therapy’s Cognitive and Mental Health Special Interest Group; and a member of the Editorial Advisory Group for PT in Motion.
Ms. Wharton has authored book chapters addressing geriatric and ethical issues in physical therapy including: “Environmental Design: Accommodating Sensory Changes in the Elderly” in Geriatric Physical Therapy, 3rd edition; “Enhancing Professional Accountability: Inquiry into the Work of a Health Profession’s Ethics Committee,” in Educating for Moral Action: A Sourcebook in Health and Rehabilitation Ethics; and “Ethics” in Geriatric Rehabilitation Manual, 3rd edition. She recently submitted a chapter, “Ethical Issues in the Rehabilitation of Geriatric Patients” for publication in the upcoming book, Rehabilitation Ethics for Interprofessional Practice. She has also published over 40articles on ethics in various publications, including the PPTA Newsletter, GeriNotes, and Topics in Geriatric Rehabilitation, and has served as an invited speaker on geriatrics and ethics topics for APTA’s Ethics and Judicial Committee, APTA’s Combined Sections Meetings, and at PPTA Chapter meetings.
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