1. What kind of legal and/or ethical issues can arise in end of life care? Bellringer

2. Jackilyn Malone, RN, BSN Montgomery County ATC Legal & Ethical Issues In End of Life Care

3. In the News Terri Schiavo Dr Kevorkian Brittany Maynard Million Dollar Baby https://www.youtube.com/watch?v=o4SUU7XoRl8 https://www.youtube.com/watch?v=fzcD-riGHMY

4. Today’s activity You will randomly be divided into two groups A case with legal/ethical concerns will be presented The two groups will have time to discuss and research and prepare and argument for their “side” of the case But first, some facts and terms that will help you!

5. Ethics in Medicine How many ethics cases do you think there are each year? No known #, but with all we see in the news, I am sure it is high!

6. Terms to know Advance directive A document stating a person’s wishes about health care for future purposes, when that person cannot make his or her own decisions Legal document Must be signed by physician Patient must be mentally competent at time of declaration

7. Terms to Know Living Will Document about measures that support or maintain life when death is likely Tube feedings Ventillators Resuscitation May instruct physicians: Not to start measures that prolong dying To remove measures that prolong dying

8. Terms to Know Durable Power of Attorney (PoA) for Health Care Type of advance directive that gives the power to make health care decisions to another person That person is usually called the health care proxy When a person cannot make health care decisions, the health care proxy can do so Does not apply to property or financial matters

9. Terms to Know Do Not Resuscitate Order (DNR) If person codes (dies) this order says that they do not wish to be resuscitated, they want to die in peace. These patients wear a certain bracelet and it is usually posted over their bed if they are a DNR Can they change their mind? YES!

10. Terms to Know Right to Die (Dying with Dignity) refers to various issues related to the decision of whether an individual should be allowed to die, when s/he could continue to live with the aid of life support, or in a diminished or enfeebled capacity. It also refers to the idea that a person with a terminal illness should be allowed to commit suicide before death occurs or should have the right to refuse to have his/her life extended by artificial or heroic means Currently in 3 states; 20 states so NO; In progress in all other states

11. For the HCP What is most important for the HCP to do in relation to a person’s wishes for end of life care? RESPECT THEM

12. Break Take a 5 minute break Bathroom Water Stretch legs

13. Group Activity I will divide you into random groups I will present a case to you With your group, you will take the facts, do any additional research and prepare an argument for your “side” of the case. You will need a secretary (to write down all notes, suggestions, ideas) and a speaker (one person to present & debate your side) HW: You will each write a short paper on your feelings of the case after the debate is finished

14. Girl Katie, 24, F born with Cystic Fibrosis Hereditary disease Thick mucus clogs lungs Median life expectancy for CF patients 40 years Avg life expectancy in US 78 years

15. Girl Meets Boy Katie meets Dalton…who also has CF They meet, fall in love, get married CF patients are heavily cautioned their whole lives to no be around other CF patients due to cross-transmission of particular infections Enter Burkholderia cepaciaBurkholderia cepacia

18. Boy gets new lungs In November of 2014, Dalton, on parent’s insurance plan received a bilateral lung transplant Immunosuppressant drugs Isolation from Katie for protection

19. Girl needs new lungs Katie has two types of insurance, Medicare & Kentucky Medicaid Medicare declares Katie has reached her lifetime maximum allowed Medicaid can’t cover a lung transplant in another state (UPMC in PA) unless they are a Ky Medicaid provider Katie begins fundraising campaign as Dalton recovers from his transplant

20. Where are they now? Dalton has been released from UPMC and made a trip to see Katie at UK…he can’t go in her room or hug her. Katie has raised over $50,000 to go toward medical expenses and has had her story shared throughout the US UPMC has agreed to start process to be a KY Medicaid provider http://www.cnn.com/2015/04/01/health/cystic-fibrosis- lung-transplant-couple/index.html http://www.cnn.com/2015/04/01/health/cystic-fibrosis- lung-transplant-couple/index.html

21. The Debate Topic Knowing what you know about CF, it’s symptoms, treatment & curability, should a patient with CF be given multiple transplants when others are on the waiting list as well? Why or Why not?

22. Homework: Write about your feelings on this specific case. Needs to be at least one page in length. If handwritten, 1.5 pages and must be legible or it will be returned with a zero. You may email it to me, but if you do, it needs to be sent as an attached document, not just an email. Make sure to use spell/grammar check and correct your mistakes