Vulnerable Adults in Healthcare Settings:

Vulnerable Adults in Healthcare Settings: Are Their Human Rights Uplifted or Violated?

The following essay discusses the ethical issues of vulnerable adults in health care settings. This paper will use a slightly different perspective, that of a vulnerable adult who is given a choice between a formal healthcare setting, and the healthcare setting of his home during his final days. Using a vignette case study, the issue of the elder patient's human rights is discussed. Often, the issue of elder care involves questions of whether the adult's biophysical needs trump their psychological needs, essentially coming down to the issue of autonomy vs. physical needs. Issues of elderly's rights in their health care is explored through the case study, with relevant discussion on human rights for the elderly needing health services.

Case Study - Mr. Jones, age 74, End Stage Cancer

End of life issues for the elderly present a range of ethical issues for elder care management. The biopsychosocial model of health care delivery offers a holistic approach to addressing issues faced by the elderly (Matsuoka, Otsuka, Koyama, Hatabe, Funai, & Tanaka, 2010). While health concerns are certainly a topic of much interest especially relating to the unique needs relating to aging and physiology, another primary concern is psychological health of the patient, including their rights in their healthcare decisions (Monod & Sautebin, 2009).

Mr. Jones is a 75-year-old widower diagnoses with terminal cancer, that of Adeno Carcinoma of the Left Lung, which has metastasized to his liver, brain, and spleen. He lives alone, though he has two grown children. He has expressed a desire to die at home, and has engaged Hospice Services, palliative care during his final days. Despite living in an affluent area, he appears to have little food available, and limited funds for medication. Mr. Jones does not wish to have his children involved in his care. He is experiencing pain. He has shallow breathing, impaired bowel function, impaired gas exchange due to his diagnosis, and impaired home management. Crisis intervention by the Hospice nurse helps get his pain prescription for him using Medicare funds. Though Mr. Jones is aware of the limitations of Hospice and is aware of the nature of his illness, he refuses to be admitted to a sub-acute care unit. He also refuses to sign a DNR form. Mr. Jones takes Percocet and Duragesic for pain. Other interventions include getting a supply of Ativan and Roxinal, though Mr. Jones is advised not to use them without instructions to do so. Oxygen is also ordered. Daily home health aides are requested and a social worker consult. Daily nursing visits are planned for medication instruction and evaluation. The on-call nurse is advised of the situation and asked to call Mr. Jones in the evening to answer questions and to make a visit if needed. A team meeting of hospice workers follows the next day.

An Issue of Human Rights

An increase in the aging population is occurring throughout the world (Kelly, 1997). Longer lifespans bring with them the diseases of aging, often requiring intense care for the elderly patient (Voelker, 2010). Older people are associated with increased risk for hospitalisations due to illness or trauma (Seymore & Cannon, 2010). The nature and burden of the illness that the older person faces is related to the quality of health care services they may receive when admitted to a hospital or other clinical setting (Dossa & Capitman, 2010). In terminal cases, the patient may choose to engage Hospice services, either in the clinical setting or at home. The human rights of such patients are ethically fundamental in their quality of care through palliative care services (Brenna, Carr, & Cousins, 2007).