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Advance Care Planning: A Doctor’s Perspective

Advance Care Planning: A Doctor’s Perspective. Tulsa Estate Planning Forum October 11, 2011 Jennifer K. Clark, MD, FAAP Division Director, Palliative Medicine Departments of Internal Medicine and Pediatrics OU School of Community Medicine. What are we going to talk about?.

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Advance Care Planning: A Doctor’s Perspective

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  1. Advance Care Planning: A Doctor’s Perspective Tulsa Estate Planning Forum October 11, 2011 Jennifer K. Clark, MD, FAAP Division Director, Palliative Medicine Departments of Internal Medicine and Pediatrics OU School of Community Medicine

  2. What are we going to talk about? • Palliative Care…what is that? • A little history lesson… • Medicine • Ethics • Advance Directives: • Have you had the conversation? • Surrogate decision makers…”but I have power of attorney!” • Do Not Resuscitate Orders

  3. Palliative Care What is Palliative Care?

  4. What is Palliative Care ? Interdisciplinary care for persons with life-threatening illness or injury which addresses physical, emotional, social, and spiritual needs and seeks to improve quality of life for the ill person and his or her family. -Ira Byock, Director of Palliative Medicine at Dartmouth-Hitchcock Medical Center

  5. What is Palliative Care ? Relief from Suffering Improve Quality of Life ShareHonest Information with Patients and Families

  6. What is Palliative Care ? Palliative Care is not equal to End-of-Life Care, Hospice, “Death & Dying” Palliative Care is not dependent on prognosis Palliative Care is not just for the elderly, it is for patients of all ages Palliative Care HOSPICE

  7. What is Palliative Care ? L. Hospitium, hospitality, literally “house and guest” Home based palliative care Targets those with <6 months life expectancy Palliative Care HOSPICE

  8. Palliative Care Curative Care Disease Process Dying Process Loss/Grief/Bereavement What is Palliative Care ?

  9. A bit of history Social reform, ethics, and medicine… the perfect storm

  10. A bit of history 2 major phenomena occurred simultaneously… • The loss of prognostics • Shift from Paternalism to Autonomy

  11. Advance directives Advance Directives: A Doctor’s Perspective

  12. OK Advance Directives • A Living Will…wishes for healthcare should you become incapacitated • Health Care Proxy…your appointed surrogate decision maker _______________________________________ • (Anatomical Gifts) • (General Provisions)

  13. OK Advance Directives • No Surrogacy law for medical decision making • OK law presumes you would want to be resuscitated and receive artificial nutrition and hydration

  14. Do not resuscitate orders Advance Directives: A Doctor’s Perspective

  15. OK DNR • For home or institution…for hospitalizations, an in- hospital DNR will be executed as well. • Consent form • Physician executed based on clear and convincing evidence

  16. Insurance • Medicaid…no hospice benefit for those solely covered. However, long-term care is covered. • Commercial…most have hospice benefit, but extremely variable • Medicare…has hospice benefit. However, long-term care is NOT covered.

  17. Questions? Thank you. Jennifer-K-Clark@ouhsc.edu For more information: OU Center for Palliative Care 918-619-4127 ***Website coming soon!*** Oklahoma Palliative Care Resource (OUHSC in OKC) http://www.fammed.ouhsc.edu/Palliative-Care/oklaw.htm

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