Transcript ADVANCE DIRECTIVES

ADVANCE
DIRECTIVES
DETERMINING FUTILITY AT
THE END OF LIFE
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ANTICIPATING FUTILITY
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LOSS OF DECISIONAL CAPACITY.
STATEMENT OF WISHES.
SPECIFICITY WITHIN VALUE CONTEXT.
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TREATMENTS.
OUTCOMES.
CREDIBILITY.
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MOTIVES.
INTENTIONS.
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COMMUNICATION
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DIGNITY.
VALUES.
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HUMANISTIC.
RELIGIOUS.
TRACKING VALUES.
QUALITY OF LIFE.
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ACCEPTABLE
MINIMALLY DECENT.
UNACCEPTABLE.
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BASIC ADVANTAGES
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GIVES GUIDANCE.
ELIMINATES GUESSING.
RELIEVES GUILT.
LIMITS OVERTREATMENT.
ECONOMICALLY PRUDENT.
GIFT TO SURVIVORS.
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LIVING WILL DECLARATION
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PATIENT SELF-DETERMINATION ACT. (1991)
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RIGHT TO CONSENT TO OR REFUSE
TREATMENT.
LIBERTY RIGHT [14TH AMENDMENT].
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CRUZAN.
RIGHT TO REFUSE = ABSOLUTE FOR
COMPENT ADULT.
RIGHT TO CONSENT = MEDICALLY
INDICATED TREATMENTS.
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PAIN CONTROL.
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HEALTH CARE POWER OF
ATTORNEY
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DURABLE POWER OF ATTORNEY FOR
HEALTHCARE.
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DESIGNATION OF TRUSTED AGENT.
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PROVIDE DOCUMENTED DIRECTIVE.
NO TRUSTWORTHY AGENT?
EXPRESS WISHES TO PHYSICIAN WHO
DOCUMENTS THEM IN THE CHART.
AVOID INFORMAL STATEMENTS THAN CAN LEAD
TO CONFLICT.
NEXT OF KIN.
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CONFLICT.
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OHIO LAW
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PERMANENT LOSS OF DECISIONAL
CAPACITY.
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TEMPORARY LOSS WHEN HEALTHCARE
AGENT CAN MAKE NON-LIFE-SUSTAINING
DECISIONS.
TERMINAL CONDITION.
PERMANENTLY UNCONSCIOUS
STATE.
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PARTICULAR INTERVENTIONS
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*RESUSCITATION.
*TUBE FEEDINGS.
*PAIN MEDICATIONS.
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HOW FAR? – TERMINAL [PALLIATIVE] SEDATION?
VENTILATOR SUPPORT.
CARDIAC MEDICATIONS.
DIALYSIS.
CHEMOTHERAPY.
RADIATION.
ANTIBIOTICS.
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VALUE CONTEXT FOR
FUTILE TREATMENTS
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SPENDING ONE’S LAST DAYS.
RECONCILIATION WITH DYING.
ACCEPTANCE OF DEATH.
LAST WORDS AND THOUGHTS.
RELIEVING GUILT.
ACCEPTANCE OF RESPONSIBILITY.
FOR DECISIONS.
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DESIGNATING FUTILITY
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CLINICAL JUDGMENT OF PHYSICIAN.
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NO CHANCE [OR VERY LIMITED CHANCE]
FOR RECOVERY TO ACCEPTABLE
QUALITY OF LIFE.
CIRCUMSTANCES FOR PERSONALLYDETERMINED FUTILITY.
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LACK OF ABILITY TO COMMUNICATE.
LACK OF AWARENESS.
LACK OF MOBILITY.
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MOST POWERFUL PROTECTION
TO ADDRESS FUTILITY
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SIGN THE STATE-APPROVED FORMS.
SPECIFY INTENTIONS AND WISHES IN
DOCUMENTED WAY AND BE AS CLEAR
ABOUT THEM AS POSSIBLE.
CONVERSE OPENLY AND HONESTLY WITH
PHYSICIANS, FAMILY, AND SIGNIFICANT
OTHERS ABOUT YOUR BELIEFS ABOUT
FUTILITY AND EXPRESS YOUR WISHES.
REASSESS WISHES PERIODICALLY AS LIFE
CIRCUMSTANCES AND HEALTH CONDITIONS
CHANGE.
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SOME WEBSITES
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Ohio’s Advance Directive Law (Outline)
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http://academic.udayton.edu/LawrenceUlrich/adohio.htm
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Ohio’s DNR Comfort Care Law (Outline)
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http://academic.udayton.edu/LawrenceUlrich/dnrohio.htm
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A Model Advance Directive (Outline)
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http://academic.udayton.edu/LawrenceUlrich/ad.html
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