Refusal of treatment by 16-year-old.
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The Omnibus Budget Reconciliation Act of 1987 radically redefined the relationship between nursing facilities and their residents. To explore the impact of this autonomy-enhancing but controversial legislation on nursing operations in skilled nursing facilities, two focus groups were convened. Nurse administrators identified ways in which the recently implemented legislation facilitates or inhibits resolution of the ethical conflicts they face. Participants concluded that legislation alone was insufficient to create needed reform in long-term care and recommended a multifaceted approach. A model is presented for creating a community of caring that identifies regulatory reform, professional empowerment, and organizational redesign as catalysts for a change.
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Two case reports are presented where parental care and authority is in conflict and stands against the prosperity of a child. Problems, practical and legal aspects and current perspectives in Germany are discussed in detail.
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