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The Project to Educate Physicians on End-of-life Care Supported by the American Medical Association and the Robert Wood

The Project to Educate Physicians on End-of-life Care Supported by the American Medical Association and the Robert Wood Johnson Foundation. Legal Issues. Plenary 2. Objectives. Describe legal consensus points List common legal myths and potential pitfalls. Law and ethics– United States.

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The Project to Educate Physicians on End-of-life Care Supported by the American Medical Association and the Robert Wood

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  1. The Project to Educate Physicians on End-of-life CareSupported by the American Medical Association andthe Robert Wood Johnson Foundation Legal Issues Plenary 2

  2. Objectives • Describe legal consensus points • List common legal myths and potential pitfalls

  3. Law and ethics– United States • Federal vs State • Lawmakers • legislatures, judges, executive agencies • Enforcement • criminal, civil, administrative

  4. Resolving difficult cases • Law • Ethics committees / consultants

  5. Ethics ofinformed consent . . . • Information-giving standards • standard professional • reasonable person • specific patient

  6. Ethics of informed consent . . . • Elements of information • nature of procedure • risks, common or severe • benefits • alternatives

  7. . . . Ethics of informed consent • Consent • understanding • voluntary

  8. Procedures of informed consent • Documentation • Process of deliberation • Shared decision making • Communication of news • Physicians have direct responsibility

  9. Treatment limitation at the end of life • Right to refuse any intervention • All patients have rights, even incapacitated • Withholding / withdrawing • not homicide or suicide • orders to do so are valid • Courts need not be involved

  10. Determining incapacity • General incapacity • Specific incapacity • Is there a decision? • Is the information understood? • Is the reasoning logical and with appreciation for consequences? • Is the decision sensible? • Reassess for each decision

  11. Decisions for the incapacitated • Best interests • Substituted judgment • advance directives • surrogacy laws

  12. Terminology of advance directives . . . • Advance care planning • process of discussion, documentation, implementation

  13. Terminology ofadvance directives . . . • Advance directives • instructional statement • living will • values history • personal letter • medical directive

  14. . . .Terminology ofadvance directives • Statutory • physician immunity • Advisory • patient wishes • Proxy designation • health care proxy • durable power-of-attorney for health care

  15. Appropriate use of opioids in end-of-life care • Federal and state • Principle of double effect

  16. Physician-assisted suicide • United States Supreme Court 1997 • States free to develop laws

  17. Futility • Futile for what goal • Objective determinations of benefit • Use ethics consultation / committees • Transfer of care

  18. Legal counsel and risk • State-by-state variations • Hospital counsel represents the institution

  19. Legal Issues Summary

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