chapter 16 legal issues death & dying

Harvard criteria of determining death

1. unreceptivity and unresponsivity 2. no movements or breathing 3. no reflexes 4. flat EEG Repeat all of the above tests at least 24 hours later with no change

An estimated _____ human tissue transplants are accomplished each year in the US

1.5 million

Definition of death

An individual who has sustained either: 1) Irreversible cessation of all functions of circulatory and respiratory functions (heart and lungs not working) 2) Irreversible cessation of all functions of the entire brain, including the brain stem, is dead.

Wills

An individual's formal statement of wishes to give some measure of control over the distribution of property

Patient Self-Determination Act

Health care institutions that receive federal funding must inform individuals of their right to accept or refuse treatment, to execute an advance directive, & to know options available to implement these rights

Good ACP includes formulating

advance directives

Administrator

appointed by the court

Medical examiners

appointed to their positions; required to be medical doctors

Durable powers of attorney in health care matters

empower a surrogate decision maker (an agent or health proxy) to make health care decisions on behalf of an individual even when that indiv is no longer able to act as a competent decision maker

Caring for families at & after donation

explain "first person consent" offer family members of nonliving donors the opportunity to authorize the donation of human organs & tissues from the body of their loved one provide a comprehensive program of bereavement-centered care for all donor families, including opportunities for commemoration & memoralization recognize both the rights of donor families & their contribution to donation programs appropriate contacts between donor family & transplant can benefit all

Body donation

for medical education and resources, arrangements must be made in advanced

Disposition of personal property

governed by state law of decedent's residence

Disposition of real estate

governed by state law of real estate location

Holographic will

handwritten, unwitnessed

ACP should include

health care practitioners, patients, & surrogate decision makers

Estate taxes

imposed on and paid from the decedent's estate; taxes are on the transfer of property from a decedent to his/her beneficiaries, occurs before all remaining assets in the estate are distributed to heirs or beneficiaries

Inheritance taxes

imposed on individuals who receive property through inheritance

Research has shown that engaging in advanced care planning

increases knowledge without diminishing hope, increasing hopelessness, or inducing anxiety in patients with cancer. Physicians need not avoid ACP out of concern for adversely affecting patients' psychological well-being

Advance directives

instructions to be followed if one is incapacitated & unable to participate in decision making BEFORE DEATH: Living wills, durable power of attorney in health care matters, "Five wishes" document, POLST AT/AFTER DEATH: organ tissue and donations, disposition of one's body, distribution of one's estate

Major organs that can currently be transplanted

kidney, liver, pancreas, heart, lung, intestine

Executor

named in the will

NASH

natural, accidental, suicide, homicide

Death certificate

necessary for record keeping & statistical data, claiming life insurance & other death benefits, disposition of property rights, & investigation of crime Delivered to local registrar, who signs the form, records it, & provides permit for disposition of the body

Living wills are primarily intended to

refuse certain kinds of cure-oriented interventions that are no longer relevant, request that dying be permitted to take its own natural course, ask that suffering associated with life-threatening illness be mitigated with effective palliative care, even if such care should hasten the actual moment of death

Tissue donation

skin, heart valves, corneas, bone

Probate

the process of administering & executing disposition of personal property following death

Testamentary trust

trust formed under testament and carried out upon death

Organ, tissue, and body donation

two critical advances. 1. ability to classify & compare human tissues. 2. development of immunosuppressant medication

Xenotransplantation

use of animal tissue in humans

Physician Order for Life-Sustaining Treatment

voluntary, actionable, portable documents designed to ensure that seriously-ill or frail patients can choose the treatment they want or do not want & insure that their wishes are documents & will be honored signed by health care professional, can be modified any time, DO NOT SUBSTITUTE FOR HEALTHCARE PROXY

Trusts

way to avoid expense and delay of probate, transfer assets while still living

Approx ____ indiv donate tissue each yr

30,000

Living donors are ____ of all transplants

37.5% of all donors in 2016

Nonliving donors are ___ of all donors in 2016

62.5%

One donor can restore health and heal lives of how many people

75

Uniform Anatomical Gift Act

Authorizes organ donation donor rights legislation and first person consent: registries open to individuals 18 and older; decisions are legally binding and do not require additional witnesses or family consent authorization for donation by next-of-kin: donation may be authorized by health care surrogate, donor's spouse, adult son/daughter, either parent, adult brother/sister, legal guardian, or any other person authorized to dispose of the body -- in that order. speaking to next of kin requires a great amount of sensitivity

When no specific legislation covers a particular subject, what is there

Case law: precedents set by prior court decisions

When neither legislation nor prior court decisions exist, what is there

Common law: represented by definitions contained in standard legal dictionaries

Intestacy

Indiv who die without valid will are said to have died intestate ... distribution of property is then based on assumptions made by state legislators as to a typical person's wishes. with no qualified heir, the estate escheats or passes to the state

Who can donate?

Living donors -- may be directed or nondirected Advantages? medical history is known, consent is directly from donor, organ is out of body for a short period of time

Medicare

NOW accepts billing from primary health care practitioners for engaging in ACP regarding EOL care & patient preferences

Uniform Determination of Death Act

Speaks of an individual not a person; requires irreversible cessation of the designated functions; recognizes the possibility of situations in which external interventions mask the precise status of respiratory and circular functions; requires evaluation of the capacities of the central nervous system; concludes that irreversible cessation of all functions of the brain & brain stem is the condition understood as death

The Conversation Project developed what

Starter Kits for adults, children, and those w/ Alzheimer's to initiate & help facilitate discussions about EOL care wishes

For most issues related to death, dying, & bereavement:

State law governs what is to be done and how it is done as a result, different laws and procedures may apply in different states some states might not have legislation on a given subject

Living trusts

Usually set up for the benefit of the trustor in case he/she is incapacitated and unable to act on his/her own behalf

"Five Wishes"

combines the best elements of living wills & durable power of attorney in health care matters in a simple, practical way. asks the person to express desires and provide guidance regarding: his/her health care surrogate, medical treatments, pain management and comfort care, treatment by others, what he/she wishes loved ones to know

Coroners are _____

elected into office