Legal and Ethical Issues Affecting End-Of-Life Care

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 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 patients 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 physicians 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 Nurses 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 patients wish to be

allowed to die without heroic or extraordinary measures? Question 10 What is a written physicians order instructing health care providers not to attempt CPR?

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