Download Legal and Ethical Issues Affecting End-Of

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
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

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)
Directive to physicians
A
written document specifying the
patient’s wish to be allowed to die
without heroic or extraordinary
measures
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.
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
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
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
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
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
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.
The End
Quiz
Question 1
Who
makes the
decisions
regarding end of
life care?
Question 2
Complete
and total
heroic measures, which
may include CPR, drugs,
and mechanical
ventilation is referred to
as what?
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?
Question 4
What
is another
name for DNR or
“no code”?
Question 5
What
is the general term
used to describe the
documents that give
instructions about future
medical care and
treatments?
Question 6
Who
should be
aware of legal issues
and the wishes of
the patient?
Question 7
What
has replaced
the idea of living
wills in most
states?
Question 8
Nursing
care of dying
patients is ________ and
encompasses all aspects
of psychosocial and
physical needs.
Question 9
What
is a written
document specifying the
patient’s wish to be
allowed to die without
heroic or extraordinary
measures?
Question 10
What
is a written
physician’s order
instructing health care
providers not to
attempt CPR?