Legal & Ethical Issues In End of Life Care

What kind of legal and/or ethical issues can arise in end of life care?BellringerJackilyn Malone, RN, BSNMontgomery County ATCLegal & Ethical Issues In End of Life CareIn the NewsTerri SchiavoDr KevorkianBrittany MaynardMillion Dollar Babyhttps://www.youtube.com/watch?v=o4SUU7XoRl8https://www.youtube.com/watch?v=fzcD-riGHMYTodays activityYou will randomly be divided into two groupsA case with legal/ethical concerns will be presentedThe two groups will have time to discuss and research and prepare and argument for their side of the case

But first, some facts and terms that will help you!Ethics in MedicineHow many ethics cases do you think there are each year? No known #, but with all we see in the news, I am sure it is high!Terms to knowAdvance directiveA document stating a persons wishes about health care for future purposes, when that person cannot make his or her own decisionsLegal documentMust be signed by physicianPatient must be mentally competent at time of declarationTerms to KnowLiving WillDocument about measures that support or maintain life when death is likelyTube feedingsVentillatorsResuscitation

May instruct physicians:Not to start measures that prolong dyingTo remove measures that prolong dyingTerms to KnowDurable Power of Attorney (PoA) for Health CareType of advance directive that gives the power to make health care decisions to another personThat person is usually called the health care proxyWhen a person cannot make health care decisions, the health care proxy can do soDoes not apply to property or financial matters

Terms to KnowDo Not Resuscitate Order (DNR)If person codes (dies) this order says that they do not wish to be resuscitated, they want to die in peace. These patients wear a certain bracelet and it is usually posted over their bed if they are a DNR

Can they change their mind? YES!Terms to KnowRight to Die (Dying with Dignity)refers to various issues related to the decision of whether an individual should be allowed to die, when s/he could continue to live with the aid of life support, or in a diminished or enfeebled capacity.It also refers to the idea that a person with a terminal illness should be allowed to commit suicide before death occurs or should have the right to refuse to have his/her life extended by artificial or heroic meansCurrently in 3 states; 20 states so NO; In progress in all other statesFor the HCPWhat is most important for the HCP to do in relation to a persons wishes for end of life care?

RESPECT THEMBreakTake a 5 minute breakBathroomWaterStretch legsGroup ActivityI will divide you into random groupsI will present a case to youWith your group, you will take the facts, do any additional research and prepare an argument for your side of the case. You will need a secretary (to write down all notes, suggestions, ideas) and a speaker (one person to present & debate your side)HW: You will each write a short paper on your feelings of the case after the debate is finishedGirlKatie, 24, F born with Cystic FibrosisHereditary diseaseThick mucus clogs lungsMedian life expectancy for CF patients40 yearsAvg life expectancy in US78 years

Girl Meets BoyKatie meets Daltonwho also has CFThey meet, fall in love, get marriedCF patients are heavily cautioned their whole lives to no be around other CF patients due to cross-transmission of particular infectionsEnter Burkholderia cepacia

Boy gets new lungsIn November of 2014, Dalton, on parents insurance plan received a bilateral lung transplantImmunosuppressant drugsIsolation from Katie for protectionGirl needs new lungsKatie has two types of insurance, Medicare & Kentucky MedicaidMedicare declares Katie has reached her lifetime maximum allowedMedicaid cant cover a lung transplant in another state (UPMC in PA) unless they are a Ky Medicaid providerKatie begins fundraising campaign as Dalton recovers from his transplant

Where are they now?Dalton has been released from UPMC and made a trip to see Katie at UKhe cant go in her room or hug her.Katie has raised over $50,000 to go toward medical expenses and has had her story shared throughout the USUPMC has agreed to start process to be a KY Medicaid provider

http://www.cnn.com/2015/04/01/health/cystic-fibrosis-lung-transplant-couple/index.htmlThe Debate TopicKnowing what you know about CF, its symptoms, treatment & curability, should a patient with CF be given multiple transplants when others are on the waiting list as well? Why or Why not?

Homework:Write about your feelings on this specific case. Needs to be at least one page in length. If handwritten, 1.5 pages and must be legible or it will be returned with a zero. You may email it to me, but if you do, it needs to be sent as an attached document, not just an email. Make sure to use spell/grammar check and correct your mistakes