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Reflect on an experience from which you can analyse your developing…

- - - - Using ethical reasoning to decide on a course of action.
        
        according to litt Principlism can provide an appropritate framework for ethical decision making for elder caregivers (in the endeavour to enhance quality of life)
        
        4 principles
        
        respect for autonomy
        
        litterature about the importance of patient Autonomy
        
        determing the autonomy Vs paternalism balance
        
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        how woud this have helped me?
        
        I may have now gained a greater understanding through writing this essay, however even if i had had the same degree of the understanding then I am unsure whether this would have ultimately changged the outcome for my grandmother.
        
        when would these recommendations have worked/ not worked
        
        Although i may have understood that these conflicts of interest were competiting I probably did not really understand this notion that a perfect solution for my grandma may not exist. If I had I may have been a little more accepting of finding myself within an ethical dilemma.
        
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        In the ethical approach, decision-making capacity is a relative matter and by no means a black and white situation. ALIREZA PARSAPOOR)
        
        In modern medical ethics, patient autonomy is considered a major principle in making decisions about an individual’s health, and those who receive healthcare should have the right to practice their autonomy consciously and freely; healthcare providers, on the other hand, are obligated to respect this right and allow patients to practice their autonomy in the course of their treatment. (ALIREZA PARSAPOOR)
        
        Autonomy of my grandmother to make her own decisions was put into question due to her mental disabilities (i.e. forgetfulness, and anxiety) and so her care/ ife decisions were now answered by my father and aunts, and now indirectly by me...
        
        her autonomy conflicted with...
        
        her autonomy and her non maleficience/ beneficence
        
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        autonomy of grandma vs my autonomy
        
        autonomy vs my/ dad and family beneficence
        
        In a study- The analysis revealed three main ethical dilemmas: When the autonomy of the person with dementia conflicted with (1) the family carer’s and professional caregiver’s need to prevent harm (non-maleficence) (2) the beneficence of family carers and professional caregivers (3) the autonomy of the family carer. (Ethical dilemmas concerning autonomy when persons with dementia wish to live at home: a qualitative, hermeneutic study, Kari Lislerud Smebye)
        
        what is dementia?
        
        I had never really questioned what dementia was.
        
        How could i be a good caregiver if I did not understand the syndrome she was experiencing?
        
        jjjshj
        
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        communication skills and dementia
        
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        beneficence 'doing good'
        
        non-malificence
        
        justice
        
        Utilitarianism: the decision-maker evaluates harms and benefits of alternative decisions using a calculus/weighting approach. Under act utilitarianism, the decision would be to select the act where the benefits to the stakeholders exceed the harms (i.e., net benefits are greater than any other act I might take) = CONSEQUENCES
        
        different stakeholders interests in this situation
        
        Was it in her best interest for me to be there?
        
        consider literature
        
        autonomy is important for good quality of life
        
        Did the situation benefit her wellbeing compared to the alternative solutions?
        
        cons of living with her children
        
        ialthough the anticipated outcome from living with her children was iin her mind positver, it may not have been as she imagined, Some articles suggest happiness when living with dementia?
        
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        harms of me being there and benefits of putting her in a home
        
        emotional cost: I could sometimes hear her on the phone to my aunts/dad in hysterics - a side i never got to see which made me think that she was hiding her vulnerabilites from me and trying to be strong which may have been emotionally taxing for her. However the same emotional cost would probably apply in a care home as she would care about appearances and would want to please people around her whcih would also mean she would not relac and cause her emotional exhaustion. I knew the personallity trait of hers as I would see how she would change and make efforts to make conversation with strangers as well as ask me if she was 'street worthy' before leaving the house.
        
        I would only be there temporarily so the outcome would not change, it would just be delayed.
        
        would create instability as she would need to adjust to me being there and then me leaving which may not be fair on her
        
        the home was one of the most expensive and meant to be really nice, with a view of the sea.
        
        benefits of me being there and the cons of a home
        
        she would retain some autonomy by remaining in her own home, a place she loved and was familiar with. Still feel part of society as people may sometimes be able to pop by.
        
        family Vs caretaker: she knew me and liked me as this is what she would tell my aunts so my company may be appreciated then that of a caretaker just doing their job. Also I may be more tolerant to her difficult nature as she was my grandmother.
        
        I could tailor and adapt my caregiver approach to her (cook her food she likes,...) which would probably be more personallised than in a care home.
        
        benefits of living with her children Vs a home
        
        felt completely comfortable with children so no emotional cost as she could just be herself.
        
        would have purpose i.e. spend time with grandchildren. compared to me living with her- i tried to make her engage in activites such as watching tv together or gardening or going for coffee but none of these activities seemed to give her any joy anymore. as she described her feeling of being in a elevator waiting for something to happen..
        
        Was it in my best interest to look after her?
        
        cons
        
        My mental health suffered from looking after my grandmother , I was never really able to leave the house for more than an hour at a time.
        
        How can i respect her autonomy without compromising my autonomy? ALso i found that her autonomy is her home sometimes conflicted with my caregivers role to prevent harm?
        
        Caring for people with dementia living in their own homes is a challenging care issue that raises ethical dilemmas of how to balance autonomy with their safety and well-being.
        
        leaving her was also difficult as I didnt know what would happen to her and by that time i did feel some degree of responsibility for her- felt guilty
        
        pros
        
        why was i was there?
        
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        was it in my dad and siblings best interest for me to be there?
        
        benefits of me being there
        
        If i think about their position, knowing how difficult my granmother could be (she may have tantrums, and say hurtful comments) I can see that they may have been afraid to live with her full time but would also feel guilty to not be able to be there for her as she envisioned. I acted as their representative and was family. So indirect presence though me as too emotionally difficult for them to deal with directly.
        
        financially saving money as paying me was cheaper then putting her back in a home
        
        harms of me being there compared to having her in a home
        
        ?????
        
        with the benefit of hindsight it is easier to identify some tof the pros and cons however at the time I made the decision to go and stay based on the knowledge and experience I had at the time.
        
        Based on the outcome of me staying, it could be argued that by being there I did not change the outcome but simply delayed it. As her memory wasnt that good at all- she may not have even remembered that I had looked after her when she was put into a home. So from this perspective maybe delaying the outcome was not the best option for her but rather the best option for my dad and his siblings and maybe it was also beneficial to me as I really got to spend some quality time with her although challenging. However this is with the benefit of hindsight as I wasn't sure what would need to return to a home after my care- although there really were no other options.
        
        It is difficult to know whether she truly enjoyed her time with me whilst I was there as she was always worrying about what would happen to her- plus she would forget the fun things i tried to make happen- so from her perspective maybe it was not beneficial. Maybe it was more beneficial to me and my father and his siblings.
        
        whos interests take precednece? weighing those interests
        
        We have to weigh those interests against each other with the aim of maximising the benefit to the most and having benefits outweigh harms.
        
        For some reason i feel like my grandmas needs should have taken precedence as she was vulnerable.However she wanted to live with her children which was not a plausible option. In this instance, maybe regardless of whether i had left or stayed the outcome would have been the same and therefore maybe my actions did not have that much an impact on the grand scheme of things.
        
        Next time if i apply the utilitarianism approach i shall rememer to include myself
        
        Deontological ethics: That people have a duty to act according to that rule, regardless of the consequences = RULES
        
        My duty to look after her as she is family and even if she is a difficult person. It is good to be caring of others.
        
        to be respectful of her wishes to be autonomous whilst also committing to look after her were duties that sometimes contradicted each other.
        
        duty to help the family no matter what
        
        Regardless of whether my grandma was going to go into a home, the act of looking after her reflected my recognition of my duty of care towards her and as well as my willingness to help my father and aunts.
        
        Did i i follow the the rule ? to be caring/ provide help to loved ones
        
        Virtue ethics
        
        if we take Aristotles virtue ethics of Eudaimonia ' living well'
        
        Then it is true that my grandma's quality of life may be decreased in a home. Last time she was in a home she suffered intense anxiety and stress which are both important determinants of pathogenesis.
        
        However from my perspective living with her was also strenuous as i was rarely able to leave the household and had no friends in the area so I was not 'living well' and my life felt like it had been put on hold
        
        living with my aunt or father may have enabled my grandma to flourish as she would have felt loved and had purpose in seeing her great grandchildren. However this would have prevented my father/ aunts to live well as they all found her to be extremely difficult and demanding person to be around.
        
        According to my moral principles, i feel like i did according to the virtues of altruism as i put her needs before mine, although I was paid to do it, in which case may mean that my actions were not purely altruistic and not completely virtuous.
        
        quality of life may be relatively better if she stayed in her own home under my care.
        
        Contractarian ethics
        
        this may have helped clarify my role to her and make her understand the alternative solution of going into a home. Signing some form of contract may have also validated her autonomy which providing some form of writing proof that I could refer to if she later on forgot . This may have helped her to respect my role as caregiver and not just a grandchild in her home. I recently spoke to my dad about this solution, and although he agrees that it may have helped to some extent, in his eyes she was too difficult a character to be reasoned with.
    - - attempted to talk to my dad, aunts but they thought that my granma was 'lucky' . Maybe it is not always possible to seek help from one of the stakeholders in the dilemma.
  - - - i used to journal alot and it is true that putting pen to paper made me think back on daily events and my responses to them. Although i have often thought back to that time I had not been willing to really analyse it again as I wasn't certain what benefit that could bring However now that I have done this essay I am aware that challenging yourself and your past actions is a process that is necessary in developing empathy and challenging personal convictions.
      - I wont try and shy away from an ethically difficult situations due to some of the negative amotions associated with them, but have a more proactive approach the situations from a place of understanding as I now realise that these may give me an opportunity to learn from others behaviour, as well as my own.
    - - I felt more as a passive participant
      - my decision was at the time to make sure
      - to do be influenced by other
      - Successful decision implementation usually requires communication
    - - “Even when the provider does the best he or she can, it may not feel good enough” knowing this is a common factor among care giver providers gives me some form of reassurance.
      - I was highly stressed during my stay and felt worn out after my time there. Everyday Ethics: Ethical Issues and Stress in Nursing Practice- managing stress is an important component of managing ethically difficult situations.
      - i think even if it does not resolve, the simple act of analysing the situation may bring me some peace of mind that I have done my best with the knowledge at hand to do what i thought was best in that situation.