When individuals who live in or participate in residential care centers need ophthalmic care, this ophthalmic care must be directed to the best interests of individual patients.

Background

Individuals who reside in or participate in residential care centers are often more vulnerable than patients who are seen in other settings.  They are dependent, they may be debilitated and may not fully comprehend the significance of what they are being told. Consequently, they are particularly susceptible to the suggestions of authority figures and to potential exploitation. 

Guidelines

The following guidelines are suggested for ophthalmologists who examine individuals residing in or participating in residential care centers:

All individuals who reside in or participate in residential care centers should be eligible for examination, not just those who might need surgery. Therapeutic decisions must be based on a complete examination, with supplemental equipment brought to the residential care center or with further examination of the patient at the ophthalmologist's office. Examinations should be conducted in a thorough and careful manner in accordance with accepted standards of medical care. The welfare of the patient is of primary importance. Explanation, reassurance or compassion may be the only care required. Auxiliaries are useful in many settings, but the ophthalmologist is responsible for patient care and must be an active participant in it.

It is unethical to recommend unnecessary treatment or to withhold necessary treatment. The appropriateness of any procedure or the determination not to perform certain procedures should be documented, and provisions for appropriate continuing care for any condition should be assured. Consent for therapy is valid only if it is given after relevant or required information has been provided. Valid consent can only be obtained from a competent patient or from someone with the legal power to consent on the patient's behalf. In the context of a residential care center, questions of competence to consent may be more common than in other settings. It must be remembered that establishing competence is a legal question and not a matter for the independent opinion of the practitioner. To better understand a patient's level of competence, the practitioner will find it helpful to consult with the staff of the residential center regarding documentation of the patient's decision-making capacity (or legal guardianship, where appropriate).