advance directives
Written instructions expressing an individuals healthcare wishes in the event that he or she becomes incapacitated and is unable to make such decisions for himself or herself
appointed decision makers
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DNR order
Directive of a physician to withhold cardiopulmonary resuscitation in the event a patient experiences cardiac or respiratory arrest
durable power of attorney
A legal instrument enabling an individual to act on another's behalf. In the health care setting, a durable power of attorney for healthcare is a legal instrument that designates and grants authority to an agent to, for example, make health care decisions
euthanasia
the good death"
-act conducted causing the death of someone who is suffering
futility of treatment
occurs when the physician recognizes that the effect of treatment will have no benefit to the patient. Morally the physician has the responsibility to inform the patient when their is no likelihood of success
guardianship
person appointed by a court to protect the interests of and make decisions for a person who is incapable of making his or her own decisions
health care proxy
Document that delegates the authority to make ones own health care decisions to another adult, known as the health care agent, when one has become incapacitated or is unable to make his/ her own decisions
living will
A document that in which an individual expresses in advance his or her wishes regarding the application of life sustaining treatment in the event that he or she is incapable of doing so at some future time. A living will describes in advance the kind of c
Oregons Death with Dignity Act
Physician suicide became a legal medical option for the terminally ill residents of Oregon. The act allows a terminally ill Oregon resident to obtain a lethal dose of medication from his or her physician. It specifically prohibits Euthanasia
Patient Self Determination Act
Provides the patients with the right to formulate advance directives and to make decision s regarding their health care. Self determination includes the right to accept or refuse medical treatment.
physician assisted suicide
Physician assisted suicide is an action in which a physician voluntarily aids a patient in bringing about his or her own death.
substituted judgement
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surrogate decision maker
An individual who has been designated to make decisions on behalf of another person determined incapable of making his or her own decisions.
withdrawal of treatment
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Describe why there is such a struggle when addressing end of life issues
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Describe the difference between active and passive Euthanasia
Active Euthanasia: Is commonly understood to be the Active: intentional commission of an act, such as giving a patient a lethal drug that results in death. If committed by the patient it is known as suicide. If anyone aids in the death, could be subject t
Describe the difference between voluntary and involuntary euthanasia
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What are the differences between allowing a patient to die and physician assisted suicide?
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Examine this statement: The inherent risk is that societies faith in doctors as healers would become subverted if doctors participate in physician assisted suicide
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Constitutionally, what gives patients the right of self determination?
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Describe Oregon's Death and Dignity Act
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What was the purpose of the Patient Self Determination act of 1990?
Provides the patients with the right to formulate advance directives and to make decision s regarding their health care. Self determination includes the right to accept or refuse medical treatment.
What are advance directives?
In the form of a living will, or double power of attorney, allow the patient to state in advance the kinds of medical care that an agent, a surrogate decision maker, to make those decisions. A person should be asked at the time of admission if he or she h
Describe how living will differs from a durable power of attorney for healthcare.
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Active Euthanasia and example
Is commonly understood to be intentional commission of an act, example giving someone a lethal drug. If the patient does it themselves then it is thought of as suicide
Passive Euthanasia and example
Happens when lifesaving treatment is withdrawn or withheld allowing the terminally ill patient to die a natural death. Example removing respirator.
Voluntary Euthanasia and example
when a person suffering when an incurable illness makes the decision to die. The request has to be made by a legally competent adult and be based on material information concerning the possible ramifications and alternatives available
Involuntary Euthanasia and example
Occurs when the decision to terminate the life of an incurable person, for example incompetent or not consenting is made by someone other then the patient.
In re storar, issue and ruling
The right of self determination was emphasized, when the court announced that every human being of adult years and sound mind has the right to choose what should be done to their body.
In re Quinlan issue and ruling
Was the first to address significantly the issue of whether Euthanasia should be permitted when a patient is terminally ill. Relied on roe v wade.
-applied a balancing test, approved the recommendation of a court appointed guardian
Superintendent of Belchertown State School v. Saikewicz (issue & ruling)
- no requirement to seek advice
-departed from the decision concerning the continuance of artificial life support from the patients guardian, family, attending physicians
In re Dinnerstein (issue & ruling)
no code, orders are valid to prevent the use of artificial resuscitative measures on incompetent terminally ill patients.
When can a court appoint a guardian?
When incompetents, have the right to refuse treatment. When the doctor has said irreversible lost of consciousness
Irreversible cessation of brain function" (p. 129); most states have brain death statutes
-definition of brain death
-most states recognize that as brain death
What are the four factors to determine the existence of patient's intention to reject prolonging life? (p. 129)
1. The persistence of statements regarding an individuals beliefs
2. The desirability of the commitment to those beliefs
3. The seriousness with which such statements were made.
4. The inferences that may be drawn from the surrounding circumstances.
Nancy Cruzman
granted authorization for termination, finding that Cruzman had the right to refuse withdrawal in death prolonging procedures
The Advance Directive for Health Care Act
deals mainly with people who have prepared living wills. It includes in its definition of life sustaining treatment the administration of hydration and nutrition by any means if It is the will. Patient must be incompetent or permanently unconscious.
Physician Assisted Suicide
-allowed in Oregon and Washington
-doctor aids a patient to end their life
Washington vs. Glucksberg
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Oregons Death with Dignity Act
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Patient Self-Determination Act Of 1990
�What is its purpose? Stipulations related to Medicare funding?
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Supreme Court of KY Living Will Directive Act (p. 138)
The act allows a judicially appointed guardian or other designated surrogate to remove a wards life support
�Courts not limited in the factors they consider to determine patient's best interests.
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Right to Die without a living will
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San Juan-Torregosa v. Garcia (issue & ruling)
Garcia, who has a chronic vegetative state, had not execute a living will, the court had no authority to authorize discontinuance of artificial nutrition.
Cruzan v. Director, Missouri Dept. of Health (issue & ruling)
recognized that a competent person had a constitutionally protected liberty interest in refusing unwanted medical treatment. An incompetent person is not able to make an informed and involuntary choice to exercise a hypothetical right to refuse treatment,
Durable power of attorney - definition & purpose
A durable power of attorney is a legal device that permits one individual, known as the principle, to give another person, called the attorney in fact, the authority to act on his or her behalf. It handles legal affairs. It is limited to the competency of
Durable power of attorney for health care - definition & purpose
A durable power of attorney is a legal device that permits one individual, known as the principle, to give another person, called the attorney in fact, the authority to act on his or her behalf. It handles legal affairs. It is limited to the competency of
Surrogate Decision Making - definition & purpose
Substituted Judgment
an agent who acts on behalf of a patient who lacks the capacity to participate in a particular decision. Agents rights are limited to any specific instructions included in the proxy document. Agents take priority over anyone except the patient. They must
Three condition for withdrawing/withholding treatment (p. 147)
1. The patient is in a terminal condition and there is a reasonable expectation of imminent death of the patient
2. the patient is in a no cognitive state with no reasonable possibility of regaining cognitive function
3. restoration will last only a brief
Patient Not in a Persistent Vegetative State - purpose
A guardian may only direct the withdrawal of life sustaining medical treatment, including nutrition and hydration if the incompetent ward is in persistent vegetative state and the decision to withdraw is in the best interest of the wards
Removal of Life-Support Equipment - purpose
-there is no duty to continue its use after it has become futile and ineffective to do so in the opinion of the medical personnel.
Feeding Tubes - purpose
-court found feeding tubes to be medical treatment
-Feeding tubes could be withheld when:
-1. It is clear that the particular patient would have refused the treatment under the circumstances involved
2. When there is some indication of the patients wishes
surrogate decision maker
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