DETERMINING FUTILITY AT THE END OF LIFE ADVANCE DIRECTIVES DETERMINING FUTILITY AT THE END OF LIFE

ANTICIPATING FUTILITY LOSS OF DECISIONAL CAPACITY. STATEMENT OF WISHES. SPECIFICITY WITHIN VALUE CONTEXT. TREATMENTS. OUTCOMES. CREDIBILITY. MOTIVES. INTENTIONS.

COMMUNICATION DIGNITY. VALUES. QUALITY OF LIFE. HUMANISTIC. RELIGIOUS. TRACKING VALUES. QUALITY OF LIFE. ACCEPTABLE MINIMALLY DECENT. UNACCEPTABLE.

BASIC ADVANTAGES GIVES GUIDANCE. ELIMINATES GUESSING. RELIEVES GUILT. LIMITS OVERTREATMENT. ECONOMICALLY PRUDENT. GIFT TO SURVIVORS.

LIVING WILL DECLARATION PATIENT SELF-DETERMINATION ACT. (1991) RIGHT TO CONSENT TO OR REFUSE TREATMENT. LIBERTY RIGHT [14TH AMENDMENT]. CRUZAN. RIGHT TO REFUSE = ABSOLUTE FOR COMPENT ADULT. RIGHT TO CONSENT = MEDICALLY INDICATED TREATMENTS. PAIN CONTROL.

HEALTH CARE POWER OF ATTORNEY DURABLE POWER OF ATTORNEY FOR HEALTHCARE. PROVIDE DOCUMENTED DIRECTIVE. DESIGNATION OF TRUSTED AGENT. NO TRUSTWORTHY AGENT? EXPRESS WISHES TO PHYSICIAN WHO DOCUMENTS THEM IN THE CHART. AVOID INFORMAL STATEMENTS THAN CAN LEAD TO CONFLICT. NEXT OF KIN. CONFLICT.

OHIO LAW PERMANENT LOSS OF DECISIONAL CAPACITY. TERMINAL CONDITION. TEMPORARY LOSS WHEN HEALTHCARE AGENT CAN MAKE NON-LIFE-SUSTAINING DECISIONS. TERMINAL CONDITION. PERMANENTLY UNCONSCIOUS STATE.

PARTICULAR INTERVENTIONS *RESUSCITATION. *TUBE FEEDINGS. *PAIN MEDICATIONS. HOW FAR? – TERMINAL [PALLIATIVE] SEDATION? VENTILATOR SUPPORT. CARDIAC MEDICATIONS. DIALYSIS. CHEMOTHERAPY. RADIATION. ANTIBIOTICS.

VALUE CONTEXT FOR FUTILE TREATMENTS SPENDING ONE’S LAST DAYS. RECONCILIATION WITH DYING. ACCEPTANCE OF DEATH. LAST WORDS AND THOUGHTS. RELIEVING GUILT. ACCEPTANCE OF RESPONSIBILITY. FOR DECISIONS.

DESIGNATING FUTILITY CLINICAL JUDGMENT OF PHYSICIAN. NO CHANCE [OR VERY LIMITED CHANCE] FOR RECOVERY TO ACCEPTABLE QUALITY OF LIFE. CIRCUMSTANCES FOR PERSONALLY-DETERMINED FUTILITY. LACK OF ABILITY TO COMMUNICATE. LACK OF AWARENESS. LACK OF MOBILITY.

MOST POWERFUL PROTECTION TO ADDRESS FUTILITY 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.

SOME WEBSITES Ohio’s Advance Directive Law (Outline) http://academic.udayton.edu/LawrenceUlrich/adohio.htm Ohio’s DNR Comfort Care Law (Outline) http://academic.udayton.edu/LawrenceUlrich/dnrohio.htm A Model Advance Directive (Outline) http://academic.udayton.edu/LawrenceUlrich/ad.html