Power of Attorney for Child in Wi

							GROUP 3
   1. Information on the Terri Schaivo Case
    (Glenn)
   2. Living Wills (Kelly)
   3. DNR Orders (Dave)
   4. Power of Attorney for Healthcare
    (Heather)
   5. Declarations to Physicians (Jenalee)
   6. Wisconsin Statutes (Mary)
   7. Case Law (Nate)
Terri Schiavo Background

   Born Theresa Marie Schindler on
    December 03, 1963 in Pennsylvania.
   Her family consists of her two parents
    and a brother and sister.
   She met Michael Schiavo at Bucks
    County Community College.
Terri Schiavo Background

   Terri & Michael were married, at age
    20 & 21, in November of 1984.
   Moved to St. Petersburg, FL with
    Terri’s parents in 1986.
   Terri & Michael never had children
    together.
What Happened?

   Feb 25, 1990: Terri suffers cardiac
    arrest.
   Brain is damaged due to lack of
    oxygen.
   June 30, 1990 Court appoints Michael
    as guardian.
   Allegations that Michael caused Terri’s
    injury have never been proven true.
Love or Money?

   August 1992: Terri awarded $250,000
    in malpractice settlement.
   November 1992: Michael Schiavo gets
    $300,000 and $750,000 put in trust
    for Terri from malpractice trial.
   May 1998: Michael petitions the court
    to have feeding tube removed.
The Battle Begins

   Terri’s parents fight to have Michael
    removed as guardian.
   Terri’s feeding tube removed and
    reinserted 3 times.
   Politicians get involved.
   Terri’s Law found unconstitutional by
    the US Supreme Court
Conclusion

   March 18, 2005:
    Feeding tube is
    removed.
   March 31, 2005: Terri
    Schiavo dies at 9:05
    a.m. at age 41.
   An autopsy was
    performed.
   April 4, 2005: Terri’s
    body was cremated.
Living Wills
   A living will states in advance a
    person's desire to receive, or to
    withhold, life-support procedures
   It is put into use if someone becomes
    permanently unconscious or terminally
    ill and unable to make decisions
Requirements to Create

   18 years or older
   Must have sound mind
   Must be witnessed by two adults
Application of Living Wills

   Living wills become applicable when
    two doctors determine that the patient
    is in an irreversible coma or unable to
    make decisions for themselves
   Cannot be used if the person is able to
    make health care decisions
Treatments Covered by
Living Wills
   Permits the withholding or
    withdrawing of life-prolonging
    treatment that artificially extends the
    dying process.
   Some states allow the removal of
    artificial nutrition when the patient is
    in an irreversible coma
Revoking a Living Will

   Can be revoked at any time by:
    – Destroying the document
    – Expressing orally to witnesses the desire
      to revoke
    – Written documentation the desire to
      revoke
DNR Order
 What is it?
 -A do not resuscitated order tells doctors,
 nurses, medical professionals and EMT’s not
 to perform CPR on them if they stop
 breathing or their heart stops
Why are they issued?
-DNR codes are normally issued when someone is critically
  or terminally ill because if CPR is performed on them
  they might still be in a worse state than they were in
  before CPR was performed.
  ex: brain damage
How are they issued?
-Any adult can write a DNR order for themselves.
-DNR can be orally to a doctor or written in a living will
   with two witnesses present.
-Doctor must acknowledge you DNR order and if they do
   not agree with a DNR order they must pass you on to
   another doctor or try to persuade you the other way
   before the DNR order comes about.
-If you cannot decide for yourself, if two doctors agree that
   CPR would not work they will not perform CPR.
-A Child DNR order can be issued with the consent of the
   guardians and if the child is old enough to understand
   they also have to consent to this decision.
 When you are personally not able to consent to a
        DNR order who can in your place?
A close family member or close friend when:
  1.you are terminally ill
  2.you are permanently unconscious
  3.CPR will not work
  4.CPR will impose burden on medical conditions
-but this decision MUST be made on your thoughts of your
  best interest
                    Miscellaneous
-Any adult can write a DNR order
-You can also remove a DNR order at any time
-If you are transferred from a hospital to a nursing home or
   nursing home to home care, etc you have to transfer
   your DNR and make sure that your doctor is informed of
   this fact.
-If CPR is going to be futile for you doctor can forgo CPR
   but must inform your family and they must agree
-If family disagrees with the DNR order they will make
   every way to communicate to patient and family to drop
   it, but in difficult cases they will normally perform CPR
   anyways to try to save the patient.
-Emt will perform CPR even if you have a DNR order
Power of Attorney for
Healthcare


  You  may voluntarily elect a person to
  make medical care, custody and
  treatment decisions for you if you
  become unable to express your
  medical care
Your Agent is granted
authority over a number of
things.
   Consent to, or refuse to consent to, various medical
    treatments
   Access your medical records
   Make arrangements such as at a hospital or nursing
    home
   Hire and fire your health care providers
   Move you to a different state
   Visit you
   Execute legal documents on health care matters for
    you
The things your agent
cannot do by law.


   Revoking your living will

   May also prohibit authorizing the withdrawal
    of life support
Who may sign a Power of
Attorney for Healthcare?


               Sound Mind

           Age 18 or older
Who may not be a witness.


   Not related to you by blood, marriage,
    adoption and not be directly financially
    responsible for your healthcare
   Not a healthcare provider who is serving
    you at the time the document is singed
   Anyone who has a claim on any portion of
    your estate
What happens if the person
I appoint dies or is not able
to serve as my agent?


           Successor agents
What happens if I name my
spouse as my agent and we
are later divorced?


   The ex-spouse will no longer have the
    authority to act under the healthcare power
    of attorney
Will my agent be held liable
for my healthcare costs?

   No
When does it take effect?



   Finding incapacity by 2 physicians, or one
    physician and one licensed psychologist
Can it be revoked?


    Yes, by…
    1. Canceling
    2. Defacing
    3. Obliterating
    4. Burning
    5. Tearing
Steps

   Let people know your feelings
   Consider the future kinds of treatment
    decisions
   Name a person you trust
   Fill out a form
   Make sure you are specific in your wording
   Make it in writing
   Disperse the form
   Make the statement part of your medical
    record
WI Statutes

Declaration   to Physicians/ Living Wills ~ W.S.A. 154
DNR ~ W.S.A. 154
Power of Attorney for Healthcare ~ W.S.A. 155
Declaration to
Physicians/ Living Wills
   W.S.A. 154.03
    – Must be of sound mind
    – 18yrs or older
    – 2 Witnesses
         Who is not eligible?
           – Individuals related by blood, marriage or adoption
           – Knowledge of declarant’s estate
           – Individual in charge of declarants financial
             healthcare
           – Someone who is a healthcare provider: social
             worker
Revocation of declaration

   W.S.A. 154.05
    – Method
        Physical
        Written

        Oral

        By executing a subsequent declaration

    – Revocation shall be recorded by the
      physician
Do Not Resuscitate (DNR)

   W.S.A. 154.17 (2)
    “a written order issued under the
    requirements of this subchapter that
    directs emergency medical
    technicians, first responders and
    emergency health care facilities
    personnel not to attempt
    cardiopulmonary resuscitation on a
    person for whom the order is issued if
    that person suffers cardiac/ respiratory
Revocation of DNR

   W.S.A. 154.21
    – Verbally to first respondent
    – Physical removal of bracelet:
         defaces, burns or cut off
Power of Attorney for
Healthcare
   W.S.A. 155.05
    – Must be of sound mind
    – 18yrs or older
    – 2 Witnesses
To Revoke Power of
Attorney for Healthcare
   W.S.A. 155.40
    a) Physical destruction
    b) Verbal (presence of 2 witnesses)
    c) Written
    d) Marriage/ divorce
    e) Executing a subsequent power of
      attorney for health care instrument
Declarations to
Physicians
(Living Wills)
     Definition: A Declaration to
      Physicians forms makes it possible
      for adults to state their preferences
      for life-sustaining procedures and
      feeding tubes in the event the
      person is in a terminal condition or
      persistent vegetative state.
Definition (cont’d)
    The withholding or withdrawal of any
     medication, life-sustaining procedure,
     or feeding tube may not be made if
     the attending physician:
1.   Advises that doing so will cause pain
     or reduce comfort.
2.   The pain or discomfort cannot be
     alleviated through pain relief
     measures.
     Terminal Illness
   Definition: an incurable condition caused
    by injury or illness that reasonable medical
    judgment finds would cause death
    imminently, so that the application of life-
    sustaining procedures serves only to
    postpone the moment of death.
Persistent Vegetative
State
   Definition: a condition that reasonable
    medical judgment finds constitutes
    complete and irreversible loss of all
    the functions of the cerebral cortex
    and results in a complete, chronic, and
    irreversible cessation of all cognitive
    functioning and consciousness, and a
    complete lack of behavioral responses
    that indicate cognitive functioning,
    although autonomic functions
    continue.
Requirements
   2 witnesses are
    required, must be at
    least 18 years old, not
    related by blood,            Witnesses cannot be
    marriage, or adoption,        persons who know
    and not directly              they are entitled to
    financially responsible       or have a claim on
    for your health care.         any portion of your
                                  estate.
   If unable to sign, the
    declaration must be          Witnesses cannot be
    signed in the                 a health care
    delcarant’s name by           provider, unless a
    one of the witnesses or       chaplain, social
    another person                worker, or employee
    designated by the             of an inpatient care
    delcarant.                    facility in which you
     Ways to Protect your
     Declaration to
     Physician
   Make friends and           Notify your attending
    relatives aware that        physician that you
    you have signed the         have a declaration.
    document and where         Make sure the
    it is kept.                 attending physician
   Keep a signed form in       keeps the document
    a safe, easily              with your medical
    accessible place.           records
Ways to Revoke your
Declaration
1.   By a written revocation of the declarant
     expressing the intent to revoke, signed
     and dated by the declarant.
2.   By executing a subsequent declaration.
3.   By a verbal expression by the declarant of
     his/her intent to revoke the document.
4.   By being cancelled, defaced, obliterated,
     burned, torn, other otherwise destroyed
     by the declarant or some person who is
     directed by the declarant.
Case Law
Spahn v. Eisenberg
563 N.W.2d 485 (Wis. 1997)
Facts of Case

   Spahn sought remedy from courts
    because wanted her sister to no longer
    have nutrients given to her
   Edna was not categorized as being in
    a permanent vegatative state. She
    suffered from dementia but was not
    expected to improve
Facts of Case Contin.

   No advanced directives
   Support system would have been
    discountinued if all family agreed.
    Niece declined
   Guardian ad litem was appointed
    during proceeding
   Lower court dismissed case
Questions for Court

   Can the guardian of a non-vegetative
    but incompetent person discontinue
    support systems?
   Answer: NO
Questions for Court

   Was there sufficient evidence present
    to conclude that Edna would rather die
    than live with supports?
   Answer: NO
Reasoning for 1st Answer
   Precedent requires that “clear and
    convincing” evidence be presented in order
    to end the life of a person who is
    incompetent
   Precedent states that a competent or
    incompetent person has the right to refuse
    medical treatment through advanced
    directives and other recognized means of
    refusal and that a legal guardian may carry
    out those wishes
Reasoning for 1st Answer
    There are four main considerations to which the
     state must adhere in respects to decisions about
     incompetent persons:
1.   The preservation of life is the most important
     factor in the states decision.
2.   The state must strive to safeguard the integrity of
     the medical profession.
3.   The state cannot participate in an act that results
     in euthanasia.
4.   The state must attempt to protect innocent third
     parties.
Reasoning for 2nd
Answer
   The only supporting evidence that
    Edna would not want to live in her
    current state was made 30 years prior
    to this case, during a family crisis.
   The comments that were made did not
    provide any solid evidence of Edna’s
    wishes.
IMPORTANCE!!!

   The court has created a “bright line”
    rule stating that incompetent persons
    may not have life-support systems
    withdrawn unless the following
    conditions are present:
Conditions:

1.   The incompetent person is in a
     permanent vegetative state and
     doing so is in the person’s best
     interest.
2.   The incompetent person has left
     advanced directives or
3.   There is clear and convincing
     evidence of the incompetents wishes.