LEGAL AND ETHICAL ISSUES AFFECTING END-OF-LIFE CARE:

ADVANCE DIRECTIVES
Issues:
 The outcomes related to their care should be their own wishes
 The decisions may involve the choice for:
 Organ and tissue donations
 Advance directives
 Resuscitation
1. Advance directives – general term for documents that give instructions about future
medical care and treatments
1.1. Living will
o First advance directive
o Lay term to describe any number of documents that give instructions about future
medical care and treatments or the wish to be allowed to die without heroic or
extraordinary measures should the patient be unable to communicate for self
o Most states have replaced the idea of living wills with the natural death acts
o These include:
1.1.1. Directive to Physicians (DTP)
 Written document specifying the patient’s wish to be allowed to die without
heroic or extraordinary measures
1.1.2. Durable Power of attorney for health care (DPAHC)
 Document used for listing the person/s to make health care decision should a
patient become unable to make informed decisions for self
1.1.3. Medical power of attorney (MPOA)
 Same as DPAHC (depends on state)
 Person appointed may be called a health care agent, surrogate, attorney-in-
fact, or proxy
1.2. Do Not Resuscitate Order
o Written physician’s order instructing health care providers not to attempt CPR
o Often requested by family
o Must be signed by a physician to be valid
o Several types of CPR decisions can be made, including:
1.2.1. Full Code
 Complete and total heroic measures, which may include CPR, drugs, and
mechanical ventilation
1.2.2. Chemical Code
 Use of drugs for resuscitation without the use of CPR
1.2.3. DNR or “no code”
 Allows the person to die with comfort measures only and without the
interference of technology
 Becoming known as allow natural death (AND) or comfort code
1.2.4. Out-of-hospital DNR
 Use by terminally ill patients who wish to have no heroic measures used to
prolong life after they leave an acute care facility
1.3. Withholding or Withdrawing Treatments
Nurse’s Responsibilities
 Be aware of legal issues and the wishes of the patient
 Nursing care of dying patients is holistic and encompasses all aspects of psychosocial
(grieving process) and physical needs (physical changes that are associated with dying)
 Focus on patient and family: respect, dignity and comfort
 Recognize own needs when dealing with grief and dying