END OF LIFE

CONSENT

ADVANCE DIRECTIVES

POWER OF ATTORNEY

DO NOT RESUSCITATE

POLST

MOLST

CONSENT

• FREE AND INFORMED (ERD 28, 27, 26, 59)

28. Each person or the person’s surrogate should have access to medical and moral information and counseling so as to be able to form his or her conscience. The free and informed health care decision of the person or the person’s surrogate is to be followed so long as it does not contradict Catholic principles.

CONSENT

• FREE AND INFORMED (ERD 28, 27, 26, 59)

27. Free and informed consent requires that the person or the person’s surrogate receive all reasonable information about the essential nature of the proposed treatment and its benefits; its risks, side-effects, consequences, and cost; and any reasonable and morally legitimate alternatives, including no treatment at all.

CONSENT

• FREE AND INFORMED (ERD 28, 27, 26, 59)

26. The free and informed consent of the person or the person’s surrogate is required for medical treatments and procedures, except in an emergency situation when consent cannot be obtained and there is no indication that the patient would refuse consent to the treatment.

CONSENT

• FREE AND INFORMED (ERD 28, 27, 26, 59)

59. The free and informed judgment made by a competent adult patient concerning the use or withdrawal of life-sustaining procedures should always be respected and normally complied with, unless it is contrary to Catholic moral teaching.

CONSENT

• PROXY (ERD 25, 24)

25. Each person may identify in advance a representative to make health care decisions as his or her surrogate in the event that the person loses the capacity to make health care decisions. Decisions by the designated surrogate should be faithful to Catholic moral principles and to the person’s intentions and values, or if the person’s intentions are unknown, to the person’s best interests. In the event that an advance directive is not executed, those who are in a position to know best the patient’s wishes—usually family members and loved ones—should participate in the treatment decisions for the person who has lost the capacity to make health care decisions.

CONSENT

• PROXY (ERD 25, 24)

24. In compliance with federal law, a Catholic health care institution will make available to patients information about their rights, under the laws of their state, to make an advance directive for their medical treatment. The institution, however, will not honor an advance directive that is contrary to Catholic teaching. If the advance directive conflicts with Catholic teaching, an explanation should be provided as to why the directive cannot be honored.

PROXY CONSENT (LEGAL):

Process by which people with the legal right to consent to medical treatment for themselves or for a minor or a ward delegate that right to another person.

3 fundamental constraints:

1. Person making the delegation must have the right to consent.

2. Person must be legally and medically competent to delegate the right to consent.

3. Right to consent must be delegated to a legally and medically competent adult.

ADVANCE DIRECTIVES

• Written instructions

• Regarding medical care preferences

• When unable to make one’s own health care decisions

• Guide for one’s family and doctors

• Can help reduce confusion or disagreement

• Generally legally binding

Advance directives include:

• Living will

• Medical or health care power of attorney (POA)

• Do not resuscitate (DNR) order

LIVING WILL

Florida Conference of Catholic Bishops (https://flaccb.org/)

CATHOLIC DECLARATION ON LIFE AND DEATH, BOTH:

• ADVANCE DIRECTIVE

• HEALTH SURROGATE DESIGNATION

https://www.flacathconf.org/declaration-on-life-and-death

POWER OF ATTORNEY (POA)

Medical or health care power of attorney (POA). The medical POA is a legal document that designates an individual — referred to as your health care agent or proxy — to make medical decisions for you in the event that you're unable to do so.

• DURABLE POA: EVEN WHEN PERSON IS MENTALLY INCAPACITATED

• RECORD IT IN THE COUNTY COURT

Do not resuscitate (DNR) order

Request to not have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing.

Advance directives do not have to include a DNR order, and you don't have to have an advance directive to have a DNR order.

Your doctor can put a DNR order in your medical chart.

PHYSICIAN ORDERS for LIFE-SUSTAINING TREATMENTS (POLST)

MEDICAL ORDERS for LIFE-SUSTAINING TREATMENTS (MOLST)

• UNIFORM DETERMINATION OF DEATH ACT (UDDA):

• DYING -> W/IN CONTEXT OF FAITH

• ORDINARY / EXTRAORDINARY MEANS OF LIFE SUPPORT

• ASSIST / SUBSTITUTE VITAL ORGANS

• DIALYSIS

• VENT

• CPR

• KILLING OR ALLOWING TO DIE?

DETERMINATION OF DEATH

ORDINARY / EXTRAORDINARY MEANS OF LIFE SUPPORT

Uniform Determination of Death Act (UDDA):

• model state law

• approved 1981

• NATIONAL CONFERENCE OF COMMISSIONERS ON UNIFORM STATE LAWS

• AMERICAN MEDICAL ASSOCIATION (AMA)

• AMERICAN BAR ASSOCIATION (ABA)

• PRESIDENT’S COMMISSION FOR THE STUDY OF ETHICAL PROBLEMS IN MEDICINE AND BIOMEDICAL AND BEHAVIORAL RESEARCH

Determination of Death:

(1) irreversible cessation of circulatory and respiratory functions or

(2) irreversible cessation of all functions of the entire brain, including the brain stem

UNIFORM DETERMINATION OF DEATH: 1. STANDARD CRITERIA (CARDIO-PULMONARY):

 NO HEARTBEAT AND NO BREATHING or

2. NEUROLOGICAL CRITERIA; ELECTROENCEPHALOGRAM (EEG) x PARTIAL BRAIN DEATH (NOT ACCEPTABLE)  TOTAL BRAIN DEATH (YES ACCEPTABLE)

MEDULLA OBLONGATA

DYING -> W/IN CONTEXT OF FAITH

HUMAN LIFE: YES FUNDAMENTAL VALUE / NOT ABSOLUTE VALUE

USA LIFE EXPECTANCY:

• WOMEN: 81 YEARS

• MEN: 76 YEARS

• COMBINED: 79 YEARS

MANAGEMENT, RELIEF: PAIN / SUFFERING

ANALYSIS: BENEFIT / BURDEN

DIAGNOSIS -> PROGNOSIS

BIOETHICAL MEANS OF LIFE SUPPORT:

• ORDINARY (PROPORTIONATE) / EXTRAORDINARY (DISPROPORTIONATE)

CLINICAL MEANS OF LIFE SUPPORT:

• STANDARD MEDICAL PRACTICE / EXPERIMENTAL TREATMENT

ERD 56. A person has a moral obligation to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that, in the judgment of the patient, offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community.

ERD 57. A person may forgo extraordinary or disproportionate means of preserving life. Disproportionate means are those that, in the patient's judgment, do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community.

ETHICAL OBLIGATION RE. VITAL ORGANS: ASSIST / SUBSTITUTE

WHEN TO WITHHOLD OR WITHDRAW LIFE SAVING TREATMENT?

DIALYSIS: SUBSTITUTES KIDNEYS

RESPIRATOR; ASSISTS IN PROVIDING OXYGEN

VENTILATOR; DEPENDS ON THE SETTINGS: ASSIST OR SUBSTITUTE BREATHING

RESPIRATORS: ASSIST BREATHING

(NOT VENTILATOR)

VENTILATOR: PERFUSION

WEANING PROCESS

VENT ~ 2-3 WEEKS BEFORE TRACHEOTOMY

EXTUBATION

TRACHEOTOMY

(TRACHEOSTOMY)

CARDIOPULMONARY RESUSCITATION (CPR):

• ASSISTS / SUBSTITUTES HEART

Defibrillation

• treatment for cardiac dysrhythmias

• Ex. ventricular fibrillation (VF) and ventricular tachycardia (VT)

• delivers a dose of electric current to the heart

KILLING OR ALLOWING TO DIE?

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