Pro-caregiver Ethics: Patient Privacy vs Patient Health; Which is more important? - AgingCare.com

Pro-caregiver Ethics: Patient Privacy vs Patient Health; Which is more important?

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My mother is, to say the least, a non-compliant patient. Among other things, she is elderly, diabetic, anorexic, and depressed. She is a master of manipulating her care-giving staff, pitting staff against each other, and lying to get her way. She has reached a critical point in her health, in that if she doesn’t eat more, and eat proper balanced diet, she will have to have her foot amputated. She does not believe her family, her doctors, or her care givers when we tell her this, but believe that we are simply threatening her with amputation so we can get our way. At this point, she is supposedly of sound mind, so technically the care givers can’t force her to do anything, but only suggest better choices. Recently her blood sugar has been spiking near 500, so we have suspected that she had a stash of candy. One of her caregivers, a woman who has been working with my mother for more than 10 years, became so frustrated that she went through every drawer and closet until she found the candy stash, which was evidently astronomical. The nurse took the candy, and has since then regretted her decision. When she called certain family members to apologize, we told her that we supported her 100% and she should feel free to take and candy she finds in the house. I can certainly understand that this is a gray area, and that elderly patients should retain privacy, but should they retain privacy at the expense of their health? Blood sugar spikes are so damaging, and while my mother refuses to believe that, the caregivers know it to be true, and are negligent if they do not at least report the candy to a family member. My mother is distraught and seriously depressed at the loss of her freedom and privacy, but honestly, every choice she makes is a bad one, and I don’t know what else to do but to beg the caregivers to prevent her from making these choices, even if it makes them uncomfortable. The choice to gorge on candy is not the only bad one; she also refuses to drink water, refuses to eat enough (she only weight 79lbs), refuses dietary supplements such as ensure, refuses to stop drinking cokes, refuses to follow a typical diabetic diet…the list goes on and on. Is it wrong for the caregivers to force her to make better choices?

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JeanneGibbs rocks with this answer! I, too, feel for the most part that we can only do so much if a person with a relatively sound mind makes unhealthy choices. Your mother is pretty extreme, but some of this may be rebellion about losing the ability to make her own choices.
Jeanne suggested having a certified diabetes educator talk with your mom. This is a terrific suggestion. Many times people who are not family or even as close as the nurse you talk about will have more effect. However, in the end, you mother will do what she wants. It's very, very hard to watch someone we love self-destruct, but we can only do so much. Please don't feel guilty.
Take care,
Carol
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What effect has taking the candy away had? What are her blood sugar levels now? Has not having the candy caused her to eat more healthfully? How did the candy get into the house? How about the Coke (which is basically liquid candy as far as blood sugar is concerned?) Is your mother able to go shopping alone?

I think this is indeed a gray area. Is it wrong to force medications or activities or eating practices on an adult who is in her right mind? I think it is wrong, but that is a personal opinion and I can certainly see the other side of the argument. I would not judge others for carrying out what they believe to be ethical.

But ethics aside, I would look closely at what is effective. Is confiscating the candy helping? How much? Is it causing any other problems (such as more weight loss)? Is mother on insulin? I believe that eating candy and drinking Coke is not going to cause amputation -- having extremely high blood sugar is. Are there any other ways to prevent extremely high bs? Is adjusting insulin an option? Might there be a compromise on the treats? Perhaps 3 pieces of high-quality delicious candy favorites, eaten one at a time over the course of the day (instead of a whole bag of junk candy), and maybe an adjustment to insulin or meds to cover the extra carbs.

I suggest a consultation or two with a Certified Diabetes Educator. Your mother's insurance or Medicare will cover this. Explain to this professional ahead of time what the situation is. If it were me, I'd be asking how to work some treats into your mother's day and still keep the blood sugars out of the upper stratosphere. These professionals are often more knowledgeable than doctors about the day-to-day strategies of living with diabetes. Maybe if the CDE starts out by asking Mother what her all-time favorite candy is and tells her the goal is to work some of that into her daily diet she would be more inclined to believe that than she is to believe the message about all the things she can't have. A family member and a caregiver should attend these sessions with your mother.

My heart goes out to you. Is is sooooo hard to see a loved one with self-destructive behaviors, whether that be drinking excessively, refusing medicines, or eating in ways that cause extreme blood sugar spikes. I hope you find effective ways to address this.
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Unfortunately switching to sugar-free candy would not help. It is carbohydrates that cause blood sugar to rise and most sugar-free treats have as many and often actually more carbs than the sugared version. Originally it was thought that sugar was the culprit, but with better scientific understanding the ADA removed its ban on sugar and started preaching the "control your carbohydrates" message in the mid 1990s. All the sugar-free products on the market just hope they will sound healthier to the consumer.
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jeannegibbs, you are right on the mark. It is carbs not sugar alone. Sugar free sounds good but it also comes with a high price tag. I tried to get my mom to realize all this but because it came from me, even tho I took a class when my then husband was diagnosed, she refused to listen. Actually hubby did too. I had a heck of time taking care of these two when they were sane adults and should've taken at least some responsibility for their own health.
Carol is right. Unless you take total control over your mom, you will have to let her do her thing. How sad for her and you!
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The other problem with sugar-free products is that some of the highly-touted sugar-substitutes have a laxative effect. Eating a piece or two might not be a problem, but gorging on a whole bag would not only not help the blood sugar issue it would create GI distress too.
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Your mother is asserting her only independence she feels she has, free will. With all the sugar free foods on the market, she should be able to get what she wants and you can relax about what she is consuming. Maybe if she is given these choices, she might stop the rebellion and start eating more properly.
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