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Legal and Ethical Issues Affecting End-of-life Care

Legal and Ethical Issues Affecting End-of-life Care. Advance Directives. The Issues. The outcomes related to their care should be their own wishes. The decisions may involve the choice for: Organ and tissue donations Advance directives Resuscitation. Advance Directives.

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Legal and Ethical Issues Affecting End-of-life Care

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  1. Legal and Ethical Issues Affecting End-of-life Care Advance Directives

  2. The Issues • The outcomes related to their care should be their own wishes. • The decisions may involve the choice for: • Organ and tissue donations • Advance directives • Resuscitation

  3. Advance Directives • A general term used to describe the documents that give instructions about future medical care and treatments • Advance Directives include: • Living Will • Do Not Resuscitate Order • Withholding or Withdrawing Treatments

  4. Living Will • Was the first advance directive • The lay term used frequently to describe any number of documents that give instructions about future medical care and treatments or the wish to be allowed to die without heroic or extraordinary measures should the patient be unable to communicate for self • Most states have replaced the idea of living wills with the natural death acts • These include: • Directive to physicians (DTP) • Durable power of attorney for health care (DPAHC) • Medical power of attorney (MPOA)

  5. Directive to physicians • A written document specifying the patient’s wish to be allowed to die without heroic or extraordinary measures

  6. Durable power of attorney for health care • A term used by some states to describe a document used for listing the person or persons to make health care decision should a patient become unable to make informed decisions for self.

  7. Medical power of attorney • Same as durable power of attorney for health (depends on state) • Person appointed may be called a health care agent, surrogate, attorney-in-fact, or proxy

  8. Do Not Resuscitate • A written physician’s order instructing health care providers not to attempt CPR • Often requested by family • Must be signed my a physician to be valid • Several types of CPR decisions can be made, including: • Full code • Chemical code • DNR or “no code” • Out-of-hospital DNR

  9. Full code • Complete and total heroic measures, which may include CPR, drugs, and mechanical ventilation Chemical code • The use of drugs for resuscitation without the use of CPR

  10. DNR or “no code” • Allows the person to die with comfort measures only and without the interference of technology • Becoming known as allow natural death (AND) or comfort code Out-of-hospital DNR • For use by terminally ill patients who wish to have no heroic measures used to prolong life after they leave an acute care facility

  11. Withholding or withdrawing treatments • What is to be done and what is not to be done must be included in clear terms • Honoring the refusal of treatments that a patient does not desire, are disproportionately burdensome to the patient, or will not benefit the patient can be ethically and legally permissible • The decision to withhold artificial nutrition and hydration should be made by the patient or surrogate with the health care team

  12. The Nurse’s Responsibilities • Be aware of legal issues and the wishes of the patient • Nursing care of dying patients is holistic and encompasses all aspects of psychosocial (grieving process) and physical needs (physical changes that are associated with dying) • Focus on patient and family: respect, dignity, and comfort • Recognize own needs when dealing with grief and dying.

  13. The End

  14. Quiz

  15. Question 1 • Who makes the decisions regarding end of life care?

  16. Question 2 • Complete and total heroic measures, which may include CPR, drugs, and mechanical ventilation is referred to as what?

  17. Question 3 • What is the lay term used frequently to describe any number of documents that give instructions about future medical care and treatments or the wish to be allowed to die without heroic or extraordinary measures, should the patient be unable to communicate for self?

  18. Question 4 • What is another name for DNR or “no code”?

  19. Question 5 • What is the general term used to describe the documents that give instructions about future medical care and treatments?

  20. Question 6 • Who should be aware of legal issues and the wishes of the patient?

  21. Question 7 • What has replaced the idea of living wills in most states?

  22. Question 8 • Nursing care of dying patients is ________ and encompasses all aspects of psychosocial and physical needs.

  23. Question 9 • What is a written document specifying the patient’s wish to be allowed to die without heroic or extraordinary measures?

  24. Question 10 • What is a written physician’s order instructing health care providers not to attempt CPR?

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