End of Life Flashcards
What is the Patient Self Determination Act (PSDA)?
It required every health care institution to have a mechanism to inform patients of how it was going to honor an AD
What are the 3 types of ADs?
- Oral AD
- Living Will
- POA
What is an oral AD
Family and friends all state that patient would prefer…If everyone agrees, this arrangement works
Why does HCW not prefer oral ADs
They are are much more comfortable
with a written document
What is a living will?
This is a direct statement from the patient to the HCP to forego life sustaining treatment when the patient is in a terminal condition
How is “terminal condition” defined?
The pt. has less than 6 months to live or is in an Unaware Wakefulness Syndrome (UWS)
Living wills are especially good for…..
Pts. at the end of life with no family or friends left who are willing to engage in advocating for the patient
Do family wishes trump living wills in regards to end of life decisions?
LW should be respected over the family claims of knowing what the patient would want
What is a POA?
A document that allows for the appointment of an agent who can then advocate for the patient’s goals and values as the HCP works to craft a plan of care that is as respectful of those goals and values
Is a POA more or less flexible than a living will?
More
What is Physicians Orders for Life Sustaining Treatment (POLST)
An initiative that when accepted, has both requests for treatment limitations as well as requests for continuation of maximal therapeutic interventions
Other strategies that patients can use to communicate their wishes
- Videos
- Letters
- “Go wish” cards
What is the completion rate of advanced directives worldwide?
25-30%
What is a common misconception about ADs?
There are only for those who wish treatment limitations
What does WH stand for?
Witholding treatment
What does WD stand for?
Withdrawing treatment
WD treatment is done for 2 reasons
The treatment is expected to work and it doesn’t OR the patient or agent request removal
If there is no guidance about what the patient would want if regards to WH or WD treatment, the HCP….
Does a benefit/burdens analysis and bases a decision on the analysis
_______ _______ is the phenomenon that WH/WD will end with the death of the patient
Proximate cause
What is the chance of success of a resuscitation with CPR?
10-15%
What should not be considered a comorbidity?
Age alone
A DNR pertains to only what?
CP arrest
Why is a DNA order written?
Because a patient/agent requests it OR you believe that CPR would be medically inappropriate or ineffective
What are the two ways to declare death?
Cardiopulmonary criteria OR neurologic criteria
In WI, who can declare the death of hospice patients?
Hospice nurses
Does the state WI permit physician assisted suicide?
No
What state has the longest track record with physician assisted suicide?
Oregon
Physician assisted suicide is also called
Death with dignity
Common reasons for requesting physician assisted suicide include
Loss of control, loss of dignity and loss of the ability to enjoy formerly pleasurable activities
The most common diagnosis associated with request for physician assisted suicide is
Cancer
Physician assisted suicide has allowed for a slightly more open discussion of…
The existence of rational suicide
What is a mechanism of suicide in older adults?
Voluntary stopping of eating and drinking (VSED)
