Quality of Life Issues Flashcards
Describe Advanced Care Planning
- overall process in which providers can explore preferences/wishes of their pts
- often culminates into preparing an Advanced Directive
What are the 3 steps involved in creating a Advanced Care Plan
- to learn what types of decisions my need to be made around end of life
- how to consider/decide about these issues prior to end of life
- Letting others know about your preferences
Describe Advanced Directives
-legal document that goes into effect when a pt becomes incapacitated/unable to make own decisions
-can be adjusted/amended
living will, durable power of attorney for health care, DNR, DNI, organ/tissue donation
When can Advanced Directives be adjusted/amended
-at different stages of life/illness, based on changing needs/goals
What are some things one may find in an Advanced Directive
- Living Will
- durable POA for Health Care
- DNR, DNI, DNH
- Organ/tissue donation
Describe Patient Self Determination Act (1990)
- requires hospitals/HMOs to inform pts of their right to make health care decisions
- requires hospitals/HMOs to provide Advanced Directives to their pts
What are some End of Life decisions one may find detailed w/in a Living Will
- whether pt wants:
- CPR
- respirator/ventilator use
- artificial nutrition (feeding tube)
- IV hydration
- IV abx
- comfort care (palliative care, hospice)
What is a DNR
- do not resuscitate
- allows others to know that a pt doesn’t want their heart to be restarted or returned to normal rhythm
Describe Medical Futility
-an intervention that is unlikely to result in a positive outcome
Are hospitals/providers obligated to provide futile care/interventions that have no physiologic rationale or have already failed
-No, just b/c an intervention/tx/med exists doesn’t mean it is in the best interest of the pt
Describe Persistent Vegetative State
- may groan/moan
- has more upper brain stem function (able to open eyes/speak)
- may cry/smile
- may briefly move eyes toward persons/objects
- unable to follow instructions
- no purposeful movements
Describe Comatose State
- when person is in a deep stupor and does not respond to external stimuli
- eyes are closed
- can’t follow commands
- no purposeful movements
- no facial expressions or speaking
Where does damage to the brain tend to be in pt’s in Persistent Vegetative states
-cerebral cortex, thalami, or connections b/w areas of brain
How long does someone have to be in a vegetative state for it to be considered persistent
- longer than 1 month
Describe Withdrawing Care
-discontinuing tx that has already been started
Describe Withholding Care
-make decision to NOT start a tx
Does Withholding or Withdrawing Care tend to be harder
-Withdrawing
When should End of Life Conversation start
- as early as possible
- can be done routinely for all pts
- should be done whenever a pt is dx w/ terminal or chronic illness
Describe goal of Hospice
maximize quality of life and reduce suffering
- not intended for those still undergoing tx
- provides services for both family and pt
Where can Hospice be utilized
- pt’s home
- skilled nursing facility
- hospice facility
- hospitals
What are the conditions/diseases that are Indications for Hospice
- any dz/condition that has a somewhat predictable progression and easily recognizable terminal phase
- Examples: CA, CHF, COPD, chronic liver failure, dementia
What are the Typical Services Provided by Hospice
- manage pain/Sxs
- assist w/ emotional/psychological/spiritual aspects of dying
- coaches family on how to care for pt
- when needed, PT/OT/ST
- when needed, inpatient/respite care
- home visits by RNs and LPNs
- home health aide/homemaker services
- chaplain services
- SW services
- bereavement counseling
- medical equipment/supplies and meds paid for
Describe physician assisted deaths
- when providers provide necessary means/info required to commit suicide/hasten death
- pt performs act themselves
Is physician assisted death legal
- varies by state
- illegal in 42 states
- legalized in Colorado, Oregon, Vermont, Washington, Hawaii, and DC
- in legalized state physicians won’t be prosecuted for prescribing meds that hasten death as long as pt has terminal illness and <6 months to live
What is the process of Legalization of Physician Assisted Death
- varies by state specific laws and regulations
- usually need:
1. written request that is notarized by 2 people who can attest to pt’s competence/and acting voluntarily
2. 15 days after pt must repeat intent orally
3. additional 48 hrs Rx can be given
4. physician must inform pt of dx, prognosis, and therapeutic options
5. consultant must confirm pt has terminal illness
How should a clinician respond to request for physician assisted death
- find out reason for request
- provide more intense palliative care
- reaffirm pt control over tx decision
- do NOT impose values on pt
- consult trusted/wise colleague and hospital ethics board
What are reasons in favor of Physician Assisted Death
-respect of pt autonomy
-compassion for pts who are suffering
allowing pts all options at end of life
-allowing death w/ dignity
What are reasons against Physician Assisted Death
- sanctity of life
- suffering can often be relived through palliative measures
- many pts change their mind; especially when co-morbidities are treated
- fears of med abuse
- opposed notion of physician role as “healer”
