Healthcare Power of Attorney Alabama by yfo56400

VIEWS: 0 PAGES: 44

More Info
									Advance Healthcare Planning
           Law & Ethics

2010 OKAHSA Annual Meeting
     March 10-11, 2010


              Presented
                  by
   Annette Prince, J.D., L.C.S.W.
     Disaster Planning: Be Prepared
• Tornado, Ice Storm, Earthquake, Bioterrorism
  – Shelter

  – Water

  – Food

  – Flashlight

  – Radio

  – Batteries
  Disaster Planning: Be Prepared
                   Death
is not an
OPTION !
But there are
optional ways
to die.
It doesn’t have to always be a disaster !
Best Option:
Make Your Own Medical Decisions
If you can still decide for yourself,
     tell your doctor, and she will put
your decisions about end of life
treatment in your medical chart !

or not. . .
    AVOID: Unpalliative Options
80% say we want to die at home, without pain,
   surrounded by family and/or friends.
But we end up in:
Emergency Room
I.C.U.
and/or
Long-Term Care
Just
Puleez
           Palliative Care Option
Serious, Chronic,
Life-limiting Illness

Terminal

Persistent Unconscious

End Stage
BUT, LESS THAN 30 % OF US COMPLETE
ADVANCE DIRECTIVES! WHAT ARE THE
              MYTHS?
• You will die within 30 minutes after you sign it.
• You will change your mind and you can’t
  revoke it.
• Modern medicine will find a cure for your
  terminal illness or vegetative state if you
  suffer as long as humanly possible without
  pain medication.
• You hate your spouse and kids and want to
  spend all your money prolonging your death if
  you can’t take it with you.
    BUT, If you die in Oklahoma
You must prepare if you want a palliative
death in Oklahoma. NO JOKE !
The Oklahoma legislature presumes
that everyone wants tube feeding.
The Oklahoma legislature does not
provide family members with
legal authority to make medical decisions!
 Be Prepared
For Palliative Care !
Get your ducks in a row,


and documents
in order.
Next Best Options: If you are no longer
  able to make your own decisions
1.Pack your bags and move to a state that got an
  “A” in palliative care (New Hampshire,
  Vermont, Montana). Oklahoma, Mississippi
  and Alabama earned “F’s” in hospital palliative
  care. (Upside: More scenic environment)
EASY OPTION IF YOU’RE DETERMINED
      TO DIE IN OKLAHOMA !
Complete “Advance Directives”
 to make your own wishes for
 medical treatment known.
(Upside: Lower cost of “living” until you die.)
  Revocation of Advance Directive
An advance directive may be revoked in whole
  or in part at any time and in any manner by
  the declarant, without regard to the
  declarant's mental or physical condition.
A revocation is effective upon communication
  to the attending physician or other health
  care provider by the declarant or a witness to
  the revocation.
    What are “Advance Directives”?
•   Living Will
•   Appointment of Health Care Proxy
•   Donation of Organs
•   Durable Power of Attorney for Health Care
•   Do-Not-Recusitate ; Do-Not-Intubate
•   Physicians Orders for Life-Sustaining
    Treatment (POLST)
     Living Will or Proxy or Both

• "Advance directive for health care" means
  any writing executed in accordance with the
  requirements of Section 3101.4 of this title
  and may include a living will, the
  appointment of a health care proxy, or both
  such living will and appointment of a proxy;
   Oklahoma Advance Directive Act
              2006
“When” does it take effect after I sign it?
ONLY “If I am incapable of making an
   informed decision regarding my health
   care, I direct my health care providers
   to follow my instructions”.
If I die with sufficient mental capacity to
   make my own decisions, it never goes
   into effect.
      What does it look like?
An advance directive may be in
 substantially the following form:
                 LIVING WILL

If my attending physician and another physician
   determine that I am no longer able to make
   decisions regarding my health care, I direct my
   attending physician and other health care
   providers, pursuant to the Oklahoma Advance
   Directive Act, to follow my instructions as set
   forth below:
                 (1) Terminal Condition
• (1) If I have a terminal condition, that is, an incurable and irreversible
  condition that even with the administration of life-sustaining treatment
  will, in the opinion of the attending physician and another physician, result
  in death within six (6) months:
•
  (Initial only one option)
  _____ I direct that my life not be extended by life-sustaining treatment,
  except that if I am unable to take food and water by mouth, I wish to
  receive artificially administered nutrition and hydration.
•
  _____ I direct that my life not be extended by life-sustaining treatment,
  including artificially administered nutrition and hydration.
•
  _____ I direct that I be given life-sustaining treatment and, if I am unable
  to take food and water by mouth, I wish to receive artificially administered
  nutrition and hydration.
•
  (Initial only if applicable)
  __AP_ See my more specific instructions in paragraph (4) below.
          (2)Persistently Unconscious
• (2) If I am persistently unconscious, that is, I have an irreversible
  condition, as determined by the attending physician and another
  physician, in which thought and awareness of self and environment
  are absent:
  (Initial only one option)
  _____ I direct that my life not be extended by life-sustaining
  treatment, except that if I am unable to take food and water by
  mouth, I wish to receive artificially administered nutrition and
  hydration.
  _____ I direct that my life not be extended by life-sustaining
  treatment, including artificially administered nutrition and
  hydration.
  _____ I direct that I be given life-sustaining treatment and, if I am
  unable to take food and water by mouth, I wish to receive
  artificially administered nutrition and hydration.
•
  (Initial only if applicable)
  __AP_ See my more specific instructions in paragraph (4) below.
                (3)End-Stage Condition
• (3) If I have an end-stage condition, that is, a condition caused by injury,
  disease, or illness, which results in severe and permanent deterioration
  indicated by incompetency and complete physical dependency for which
  treatment of the irreversible condition would be medically ineffective:
  (Initial only one option)
  _____ I direct that my life not be extended by life-sustaining treatment,
  except that if I am unable to take food and water by mouth, I wish to
  receive artificially administered nutrition and hydration.
•
  _____ I direct that my life not be extended by life-sustaining treatment,
  including artificially administered nutrition and hydration.
•
  _____ I direct that I be given life-sustaining treatment and, if I am unable
  to take food and water by mouth, I wish to receive artificially administered
  nutrition and hydration.
•
  (Initial only if applicable)
  __AP_ See my more specific instructions in paragraph (4) below.
                (4)Other Conditions
Here you may:

  (a) describe other conditions in which you would want
  life-sustaining treatment or artificially administered
  nutrition and hydration provided, withheld, or
  withdrawn,

  (b) give more specific instructions about your wishes
  concerning life-sustaining treatment or artificially
  administered nutrition and hydration if you have a
  terminal condition, are persistently unconscious, or have
  an end-stage condition, or

  (c) do both of these:
• I authorize my health care proxy or alternate to make all
  health care decisions on my behalf, including decisions
  regarding life-sustaining treatment, including the provision,
  withholding or withdrawal of artificially administered
  nutrition and hydration.
• I want effective pain management even if it hastens my death.
  In the event that I am diagnosed with any of the above 3
  conditions, I do not want antibiotics administered.
• In the event that I am diagnosed with any of the above 3
  conditions, and my heart stops beating or I stop breathing, do
  not resuscitate or intubate me, or I will sue you.
• If my son from California objects to my directions, he inherits
  nothing, zip, zero, nada.
__AP__
   Health Care Proxy Appointment
If my attending physician and another physician determine
that I am no longer able to make decisions regarding my
health care, I direct my attending physician and other health
care providers pursuant to the Oklahoma Advance Directive
Act to follow the instructions of David Boren, whom I appoint
as my health care proxy. If my health care proxy is unable or
unwilling to serve, I appoint Steve Crawford as my alternate
health care proxy with the same authority. My health care
proxy is authorized to make whatever health care decisions I
could make if I were able, except that decisions regarding life-
sustaining treatment and artificially administered nutrition
and hydration can be made by my health care proxy or
alternate health care proxy only as I have indicated in the
foregoing sections if indicated.
If I fail to designate a health care proxy in this section, I am
deliberately declining to designate a health care proxy.
                              Witness
Signed this ___ day of ________________, 20 ___.

   _____________________________________________
   Signature
   _____________________________________________
   City of
   _____________________________________________
   County, Oklahoma
   _____________________________________________
   Date of birth (Optional for identification purposes)

   This advance directive was signed in my presence.

   _____________________________________________
   Signature of Witness
   ____________________________________, OK
   Residence

   _____________________________________________
   Signature of Witness
   _________________________________, OK
   Residence
               General Provisions
a. I understand that I must be eighteen (18) years of age or
older to execute this form.
b. I understand that my witnesses must be eighteen (18) years
of age or older and shall not be related to me and shall not
inherit from me.
c. I understand that if I have been diagnosed as pregnant and
that diagnosis is known to my attending physician, I will be
provided with life-sustaining treatment and artificially
administered hydration and nutrition unless I have, in my own
words, specifically authorized that during a course of
pregnancy, life-sustaining treatment and/or artificially
administered hydration and/or nutrition shall be withheld or
withdrawn.
d. In the absence of my ability to give directions regarding the
use of life-sustaining procedures, it is my intention that this
advance directive shall be honored by my family and
physicians as the final expression of my legal right to choose
or refuse medical or surgical treatment including, but not
limited to, the administration of life-sustaining procedures,
and I accept the consequences of such choice or refusal.
e. This advance directive shall be in effect until it is revoked.
f. I understand that I may revoke this advance directive at any
time.
g. I understand and agree that if I have any prior directives,
and if I sign this advance directive, my prior directives are
revoked.
h. I understand the full importance of this advance directive
and I am emotionally and mentally competent to make this
advance directive.
i. I understand that my physician (s) shall make all decisions
based upon his or her best judgment applying with ordinary
care and diligence the knowledge and skill that is possessed
and used by members of the physician’s profession in good
standing engaged in the same field of practice at that time,
measured by national standards.
            Make it Happen !
A physician or other health care provider who
  is furnished the original or a photocopy of
  the advance directive shall make it a part of
  the declarant's medical record and, if
  unwilling to comply with the advance
  directive, promptly so advise the declarant.
   What is a “Qualified” Patient?
• 63 O.S. Section 3101.7 Qualified Patient-
  Determination-Record

  The determination of the attending physician
  and another physician that the patient is a
  qualified patient shall become a part of the
  patient's medical record.
          Qualified Patient

"Qualified patient" means a patient eighteen
(18) years of age or older who has executed
an advance directive and who has been
determined to be incapable of making an
informed decision regarding health care,
including the provision, withholding, or
withdrawal of life-sustaining treatment, by
the attending physician and another
physician who have examined the patient.
                Proxy Power

In the case of a qualified patient, the patient's
  health care proxy, in consultation with the
  attending physician, shall have the authority
  to make treatment decisions for the patient
  including the provision, withholding, or
  withdrawal of life-sustaining procedures.
Title 63 O.S. Section3101.9 –

  An attending physician or other health care
  provider who is unwilling to comply with the
  Oklahoma Advance Directive Act shall as
  promptly as practicable take all reasonable
  steps to arrange care of the declarant by
  another physician or health care provider
  when the declarant becomes a qualified
  patient.
  Penalty for Refusal to Honor AD
• Title 63 O.S. Section3101.11 - Sanctions and
  Penalties for Certain Acts

  A. A physician or other health care provider
  who willfully fails to arrange the care of a
  patient in accordance with Section 3101.9 of
  this title shall be guilty of unprofessional
  conduct.
                    Ethics
                 Autonomy
– The Oklahoma Advance Directive Act recognizes
  the patient’s right to refuse any medical treatment
  in advance of a time when they may not be able
  to make their health decisions.
– The advance directive may be revoked at any time.
– The appointed health care proxy is entitled to all
  medical records and information that the patient
  would be entitled to if able to make decisions.
– Caregivers should be considered.
           Nonmaleficence
The patient may refuse CPR, dialysis or a
  respirator.
The patient is the authority on what is the
  greater or lesser harm.
I might prefer amputation of a leg to death.
Lance Armstrong might have other ideas.
             Beneficence
Providing effective pain management is
  a benefit to a patient if that is their
  choice.
If the physician’s intent is to relieve pain,
  there is no liability, even if the
  necessary medication hastens death
              Justice
Autonomy vs. Justice
Futile care
Limited Resources
Costs of Health Care
Life prolonging care vs.
Death prolonging care
 Plan in Advance for Palliative Care
• Palliative care should be included in every
  medical treatment plan.
• Palliative care is taken for granted when a
  patient can speak for (defend) themselves.
• Palliative care should be a part of every
  consumer’s disaster plan so that disaster is
  avoided at the end of life.
                Root Canal
• Dentist doesn’t ask if I want pain management
  or if I’m afraid of drug addiction during the
  procedure.
         Colonoscopy
Gimme
that
drip !
more !
more !
ahhh!
                Backache
Aspirin
Morphine
Surgery

Sometimes it’s just common sense to START
  with Palliative Care !
     So, If I Can’t Tell You What I Want
          Who Will Speak For Me?
1.    Health Care Proxy
2.    Living Will
3.    Legislature= feeding tubes
4.    Family= no legal authority
5.    Judge
6.    Congress
7.    Cable News
     Palliative Care Resource Center
Palliative Care is HOPE ! ! !
Discussions Blog
Oklahoma Law
News & Events
Bioethics Videos
Advance Planning Videos
http://www.fammed.ouhsc.edu/palliative-care/
It’s Your Right To Decide.

 If you don’t use it,

     You will lose it !

                  • Questions?
                 • Annette Prince
            • annette-prince@ouhsc.edu
             • Dept. of Family Medicine
                  • Room 2308
                 • (405)271-5362
 Palliative Care Resource Center

     Supplemental web site is
http://fammed.ouhsc.edu/palliativ
            e-care/

								
To top