Guideline 8.1: Global.
The core ethical principles of autonomy, substituted judgement, beneficence, justice, and nonmaleficence underpin the provision of palliative care.Guideline 8.2: Legal considerations.
The provision of palliative care occurs in accordance with federal, state, and local regulations and laws as well as current accepted standards of care and professional practice.Guideline 8.3: Screening and assessment.
The patient’s preferences and goals for medical care are elicited using core ethical principles and documented.Guideline 8.4: Treatment and ongoing decision making.
Within the limits of applicable state and federal laws, current accepted standards of medical care, and professional standards of practice, person-centered goals form the basis for the plan of care and decisions related to providing, forgoing, and discontinuing treatments.
Many patients with a serious health condition can benefit from planning personal affairs and documenting legal designations, medical authorizations and limitations. State laws vary regarding the rules, requirements, and forms used to plan and record personal, financial and medical preference. Some of the common legal documents used to record health care preferences, include:
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Advance directive designate aspects of medical care in the event of incapacity.
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A living will automatically includes the designation of a health care surrogate.
Health care surrogate:
Many people believe that if they have a living will or advance directive; they don't need to assign a health care surrogate to make decisions about their care if they cannot do so. However, critical decisions that are not covered by the living will often need to be made. If the individual does not assign a health care surrogate and cannot express his or her desires, then the laws of the state take over, and someone is allowed to make those decisions. The regular order is this:
The prolonged court battle that ensued between Teri Schiavo and her parents and her spouse over the spouse's decision to stop supportive treatments, is a prime example of what can happen if people do not make their wishes clear about end of life issues. Even members of the same family may have profound disagreements. It is the responsibility of the health care surrogate to advise the physician of the patient's wishes.
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People may need to designate a health care surrogate even though they have a living will.
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Health care surrogates can help clarify your intentions in the event of unforseen end-of-life issues.
A durable power of attorney can delegate the authority to make health, financial, and legal decisions on a person's behalf. Therefore, it can be broader than a living will. The durable power of attorney can be in effect while the person can make decisions and remains in effect when the person is not. It must be in writing and must show the person's intent to give specified power if they are incapacitated. It must expressly state that the designee can make health care decisions. A durable power of attorney is essential if a person is in the early stages of dementia and is expected to lose the ability to make his or her own decisions. In this case, he/she wishes to designate the authority to make decisions about many issues, including finances, to someone trusted.
Instant Feedback: The durable power of attorney remains in effect only while the person is incapable of making decisions.