end of life power point - death & dying
TRANSCRIPT
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Ethical and Legal Issues related to End of Life Care
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Death: an eventDying: a
processUniqueIndividual
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Changes in Death and Dying
Late 1800’sEarly to mid 1900’sIn AmericaCausesDemographic/social trendsLocation
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Death and Dying in America
Disparity between the way people die/ the way they want to die
“live until you die” (philosophy of Hospice)
Patient/family perspective
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Factors Influencing End of Life Care
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Factor: Advances in Techonology
Can be victims of technology
Dying can be extended beyond what is reasonable
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Factor: Aging Population
Possibility of physical decline
Possibility of mental decline
Fear of nursing home placement
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Factor: Medical Futility
Fear of what medicine can’t cure
Mental deterioration
Wasting away of body
Disfigurement Loss of energy Loss of control Pain Psychological
anguish
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Factor: Social/ Family systems
Fear of not being taken seriously as persons
Fear our rights will be slighted
Violation of our meaning of life
Fear someone else will control us
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Factors: Health Care
Lack of professional knowledge
Fear of litigation Access to hospice Legal/
bureaucratic obstacles
Reimbursement
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Factor: Search for Life’s Meaning
What does Life Mean for a human being?
Can human life be equated with mere biological functioning?
Can one cease being a person while still in some sense be alive?
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Factor: Search for Life’s Meaning
What meaning do we give to
dependency on others
decline and aging Pain and suffering Illness and death
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Issues Related to End of Life
Communication and Decision-makingProlongation of live vs quality of lifeWithholding or withdrawing treatmentCaring and ComfortMedical FutilityAssisted SuicideResearch
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Issues of Decision Making and Communication
ConsentConfidentialityDisclosureAdvanced Care
planningPatient Self-
DeterminationAdvanced
directives
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Difficulties with Communication
Difficulties come when families:Do not want to address issue of deathWant to protect loved ones through
silenceAre faced with death “out of
sequence”
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Issue: Prolongation of Life and Quality of Life
Acute Therapeutic care
Palliative treatment
Artificial life support
Resuscitation
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Issues of Withholding/ Withdrawing Treatment
Based on right to self determination
Balance of benefit vs. burden
Examples: Artificial feeding Hydration Ventilation dialysis
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Do Not Attempt Resuscitation/ no Code
Confirms that no measure to prolong life be carried out
Written MD order required
Often required by emergency response systems
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Issues of Care and Comfort
Professional-patient relationshipProvision of palliative careControl of symptomsPrinciple of Double Effect
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Assisted suicide/EuthanasiaAssisted Suicide
The ultimate choiceFear loss of control
Does autonomy extend to actively ending our lives
Oregon Law19941997 Supreme Court upholds law
Request often signify crisis, unrelieved suffering, plea for help
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Medical Futility
Conflicts over benefits of treatmentOften involve communication
failuresCare should be guided by values
and goals
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Issue of cost of end of life care
Futile care is costly Current system
creates severe family burden
Limits to medical interventions
Hospice care as a cost effective option
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Research at the End of Life
Need for appropriate research
Sense of obligation may exist
Issues of non-malfeasance, autonomy
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Health Care professional role
How do we address the ethical issuesValues clarification
Support for the professionalAdvocacyMember of interdisciplinary teamUse of ethics resources
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Facilitating Ethical and legal practice
As professionals in health care Practice within
the standards of care
Communicate wishes of patient in collaboration with interdisciplinary team
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Facilitating Ethical and legal practice
If patient or family are unsure of options Communications among
family members With clergy or spiritual
guide Physicians and other
healthcare professionals
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Conclusion
Victor Frankl (1959) “ We must never forget that we may also find meaning in life even when confronted with a hopeless situation when facing a fate that cannot be changed. . . When we are no longer able to change a situation. . . We are challenged to change ourselves (Frankle, 1984, p. 135)