1. 1 Ethical Issues at the End of Life Adapted from:Burack, O. R., Chichin, E. R. & Olson, E. (2000) Teaching End-of-Life Ethics to CNAs. In E. R. Chichin, O. R. Burack, E. Olson & A. Likourezos, End-of-Life Ethics and the Nursing Assistant (p.127). New York: Springer Publishing Company. Geriatric Aide Curriculum NC Division of Health Service Regulation Module 25

2. 2 Ethical Issues At The End Of Life Objectives 1. Define ethics, bioethics and ethical dilemma. 2. Discuss the following topics as related to end of life: A. Health care power of attorney B. Living will C. Advance instruction for mental health treatment D. Decision making without advance directives

3. 3 Ethical Issues At The End Of Life Objectives 2. Discuss the following topics as related to end of life (continued): E. Comfort issues F. Residents right to choose or refuse treatment G. Truth-telling H. Financial concerns I. Caring for those who have refused treatment

4. 4 Definitions  Ethics: A set of principles of proper conduct  Bioethics: Rules governing conduct of individuals in medical & healthcare professions  Ethical dilemma: A situation that requires a choice between equally favorable or mutually exclusive options

5. 5 Advance Directives:  Written instructions to health care provider in advance of need for medical treatment  Ensures an individual’s wishes are followed  Individual can refuse or consent to future treatment

6. 6 Healthcare Power of Attorney  An advance directive where a person is identified to make medical decisions for an individual when the individual is no longer able to make these decisions.

7. 7 Living Will  An advance directive for an individual to choose to have life prolonging procedures withheld if the individual has a terminal condition or is in a vegetative state.

8. 8 Advance Instruction for Mental Health Treatment  An advance directive that allows an individual to give instructions and preferences regarding mental health treatment.

9. 9 Making Decisions Without Advance Directives

10. 10 Comfort Issues  Nurse aides provide comfort care the end of life  Nurse aides perform most of the hands-on care  The time the nurse aide spends with the resident who is dying gives the nurse aide the chance to observe discomfort and provide comfort care

11. 11 The Patient Self Determination Act of 1991  Outlines rights of residents in facilities receiving Medicare and/or Medicaid funding  Includes: The right to know about treatment options The right to refuse treatment

12. 12 Truth-telling about health conditions

13. 13 Financial Concerns: The Cost of Health Care Treatment

14. 14 Caring For Those Who Have Refused Treatment

15. 15 Solving Ethical Issues  Solutions are not always easy  May go as far as needing an answer from an ethics committee  Listen to understand the other person’s perspective.

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