Exam #1: End of Life Planning & Substitute Decision Making Flashcards
What is legal autonomy in the medical context?
Right to determine what will be one w/ one’s body
What precedent does the Patient Self-Determination Act (PSDA) establish?
Mandatory to establish informed consent
What are the three things that a patient must be told during the process of “informed consent?”
1) Risks & probability of risk
2) Benefits
3) Alternatives
What will invalidate informed consent?
1) Absence of adequate information
2) Incompetence
3) Coercion
What are the general guidelines of the AMA process?
1) Determine the patient’s capacity to leave
2) Review chart & explain consequences of actions
3) Involve others to convince patient to stay
4) Have patient sign AMA form
5) Provide aftercare instructions
What are the common pitfalls of AMA that lead to legal action?
- No physician involvement
- Patient not warned of specific condition & risks of leaving
- Inadequate documentation
- No involvement of family or friends
- Incompetent patient
- Failure to provide aftercare instructions
What is the difference between wandering and elopement?
Elopement= patient is aware that he/she is NOT permitted to leave, but does so anyway w/ INTENT
Wandering= patient that strays away WITHOUT INTENT of leaving
What are the potential liabilities involved in wandering & elopement?
1) Negligence
2) Licensure
3) Accreditation
4) Potential criminal charges
What patients are at risk for elopement?
Patients that have:
1) Court-appointed legal guardian
2) Patient is considered dangerous
3) Patient is committed
4) Cognitive impairment
5) History of prior elopement
What is the difference between competency and capacity?
Competent= a decision made by a judge in court; indicates that the patient has the ability to make legal decisions
Capacity= clinical perspective on the patient’s ability to make decisions
- Transient
- Decided by the provider, not a judge
What are the two forms of advanced directives?
1) Living will
2) Durable Healthcare Power of Attorney
What are quasi-advanced directives?
1) IPOST
2) DNR
What is a Durable Power of Attorney? What is the Attorney in Fact?
The patient signed document designating the “Attorney in Fact” i.e. person that makes medical decisions
What is a Guardianship?
Court appointed person with limited ability to make decisions
What is a family hierarchy?
List of individuals that are able to make decisions for a person in the absence of a POA or Guardian
