GLOSSARY

Advance Directive: The umbrella term for a number of strategies (durable power of attorney (DPA) for health care, written instructions for the DPA, or living will) for ensuring that one's preferences for care are respected in the event one becomes unable to personally communicate them.

Ageism: Negative generalizations about the elderly that permit open or discreet bias against aging persons. Ageism can lead to unequal provision of care among the generations that is biased in favor of the young.

Autonomy: The human capacity for making personal choices based on reasoning about a situation (also often referred to as self-determination). The ethical principle of autonomy proposes that individuals areas a rule, better placed to make their own decisions for action than any other interested party.

Beneficence: The ethical principle that obliges persons to provide for the 'good' of another (i.e., promote someone's welfare) and avoid harm (i.e., prevent putting someone at risk for harm) (Fry & Johnstone, 2002). This is an especially binding principle for health care professionals who have 'professed' to be able to tend to the health care needs of their patients.

Caring: An ethical approach to the nursing care of patients that involves the nurses deliberate engagement with the patient. This 'engaged' relationship permits the meaning and context of the patient's needs to be exposed.

Competency: The legal presumption that persons are both capable of making their own decisions, and barring evidence to the contrary, have the right to do so free from interference.

Decision-Making Capacity: A person's ability to make an informed decision in accord with personal beliefs and lifestyle preferences given appropriate and adequate information.

Durable Power of Attorney: [(DPA) for Health Care] An individual who has been charged by another person to make health care decisions on his or her behalf in the event that he or she becomes incapable of making his or her own decisions regarding treatment.

Informed: The legal and ethical right of a person to make his or her own health care consent treatment decisions (including a decision to refuse treatment) requires both the possession of adequate information and freedom from internal or external restraints or coercion.

Justice: In health care settings Justice has to do with the fair distribution of, or access to, health care goods and resources. Justice (as fairness) mandates that the elderly get equal opportunities to access health care and that they are not unjustly deprived of health care resources because of age or the nature of their infirmities.

Managed Care: The term used for a variety of health care delivery arrangements in the U.S. that are ostensibly aimed at controlling the costs of health care.

Medicare: Established in 1965 by Title XVIII, Health Insurance for the Aged (an amendment to the Social Security act of 1935). This is a government program which provides health insurance for people aged 65 years and older, some people under 65 with disabilities, and people with end stage renal disease. It has 2 parts: Part A provides hospital insurance (most people do not have to pay for Part A coverage) and Part B provides medical insurance. Most people pay a small monthly fee for part B ($54 in 2002).

Medicaid: A program funded in part by states and in part by the federal government. Medicaid is a jointly-funded, Federal-State health insurance program for certain low-income and needy people. It covers approximately 36 million individuals including children, the aged, blind, and/or disabled, and people who are eligible to receive federally assisted income maintenance payments (Centers for Medicare and Medicaid Services [CMS]).

Nomaleficence: An ethical principle that obliges persons to avoid harming others. In health care settings, the principle of nonmaleficence is important because it prohibits the clinician from harming patients either intentionally or unintentionally through incompetent or unethical practice. It also puts responsibility on the health care practitioner to prevent others from causing harm or injury to a patient under their care.

Nursing Judgment: The synthesis of nursing knowledge, knowledge from other disciplines, practical experience with patients, and knowledge of a particular patient or patient group used to evaluate a patient care situation for the purposes of prioritizing and attending to health needs.

Living Will: A type of advance directive which permits persons to document their preference about end-of-life care in the event of terminal illness and an inability to communicate their wishes. Living wills can be specific or general and are legally binding (unless the patient recovers decision-making capacity and rescinds it) in some states.

Older Americans Act: Established in 1965, includes a range of programs that provide services and opportunities for older Americans, particularly those at risk of losing their independence. This Act also established the administration on aging (http://www.aoa.gov).

Paternalism: The overriding of, or interference with, an individual's right to self-determination based on the idea that the decision being made is not in the individual's best interests. A paternalistic decision is one made by someone other than the concerned individual, but in the guise of better serving the interests of that individual than would his or her own decision.

PDSA: The Patient Self Determination Act, established in1991 is a federal act mandating that all health care institutions receiving federal funds inform (all) patients of their rights to complete advance directives.

Preventive Ethics: The practice of recognizing, anticipating, and addressing health needs and problems that have not yet occurred.. These problems are foreseeable by nurses because of their knowledge base, experience, and close work with patients, in addition to their understanding of conditions conducive to poor health. Action taken to prevent future problems either at the level of the individual patient or at the institutional, community, or societal level is preventive ethics.

Risk: Susceptibility to physical or mental harm due to environmental circumstances, diminished resources, or physical decline associated with the aging process, e.g., risk for physical or mental abuse from an overworked caregiver.

Vulnerability: The potential for harm that is related to characteristics of aging including physical and cognitive fragility.