Life and Death

LIFE AND DEATH
JEA JOEL MENDOZA-DUNGCA, RN, MSN

JUNE 23,2018
CHOICES IN LIFE AND DEATH
• -Choices in Dying
• -Living will, Advance Directives
• -Patient Self-Determination Act
• -Ethical Considerations
CHOICES IN DYING
• Increases in technological possibilities and relatively high levels of
disposable income have enabled large numbers of citizens to exercise
choice in a wide variety of areas.
• However, when it comes to deciding about death, choice is a more
contentious notion.
• Death is not something any of us to think about and often much less
talked about with our loved ones.
ADVANCED DIRECTIVE
•Advanced Directives are written, legal instructions
regarding your preferences for medical care if you
are unable to make decisions for yourself.
•It guide choices for doctors and caregivers if
you're terminally ill, seriously injured, in a coma, in
the late stages of dementia or near the end of life.
•By planning ahead, you can get the medical care
you want, avoid unnecessary suffering and relieve
caregivers of decision-making burdens during
moments of crisis or grief.
•You also help reduce confusion or disagreement
about the choices you would want people to make
on your behalf.
POWER OF ATTORNEY
• a type of advance directive in which you name a person to make
decisions for you when you are unable to do so.
• durable power of attorney for health care or a health care proxy
• The person you name may be a spouse, other family member,

friend or member of a faith community. You may also choose one or
more alternates in case the person you chose is unable to fulfill his or
her role.
• Health care agent
• Health care proxy
• Health care surrogate
• Health care representative
• Health care attorney-in-fact
• Patient advocate
• You should choose a person who meets the following
criteria:
• Is willing and able to discuss medical care and end-
of-life issues with you
• Can be trusted to make decisions that adhere to your
wishes and values
• Can be trusted to be your advocate if there are
disagreements about your care
LIVING WILL
• Is a written, legal document that spells out medical treatments you
would and would not want to be used to keep you alive, as well
as other decisions such as pain management or organ donation.
• In determining your wishes, think about your values, such as the

importance to you of being independent and self-sufficient, and
what you feel would make your life not worth living.
You should address a number of possible end-of-life care decisions in your
living will. Talk to your doctor if you have questions about any of these issues:
• Resuscitation. Determine if and when you would want to be resuscitated by
cardiopulmonary resuscitation (CPR) or by a device that delivers an electric
shock to stimulate the heart.
• Mechanical ventilation. Takes over your breathing if

you're unable to do so.
Consider if, when and for how long you would want to be placed on a
mechanical ventilator.
• Tube feeding. Supplies the body with nutrients and fluids intravenously or via
a tube in the stomach. Decide if, when and for how long you would want to be
fed in this manner.
• Dialysis. Removes waste from your blood and manages fluid levels if
your kidneys no longer function. Determine if, when and for how long
you would want to receive this treatment.
• Antibiotics or antiviral. Medications can be used to treat many

infections. If you were near the end of life, would you want infections to
be treated aggressively or would you rather let infections run their
course?
• Comfort care (palliative care) includes any number of interventions
that may be used to keep you comfortable and manage pain, while
abiding by your other treatment wishes. This may include being
allowed to die at home, getting pain medications, being fed ice
chips to soothe dryness, and avoiding invasive tests or treatments.
• Organ and tissue donations for transplantation can be specified in

your living will
DO NOT RESUSCITATE AND DO
NOT INTUBATE ORDERS
• You don't need to have an advance directive or living will
to have do not resuscitate (DNR) and do not intubate (DNI)
orders.
• You can make your preferences known to your physician
• Mention your DNR and DNI in your living will.
CREATING ADVANCE DIRECTIVES
• Advance directives need to be in writing.
• Must be signed by a witness or notarized.
• Review your advance directives with your doctor and your
health care agent to be sure you have filled out forms
correctly.
REVIEWING AND CHANGING
ADVANCE DIRECTIVES
• You can change your directives at any time.
• Must create a new form, distribute new copies and destroy all old
copies.
• You should consider reviewing your directives:
• New diagnosis.
• Change of marital status.
• Change in wishes.
PATIENT SELF-DETERMINATION ACT
• It was passed by the United States Congress in
1990.
• Effective on December 1, 1991, this legislation
required many hospitals, nursing homes, home
health agencies, hospice providers, health
maintenance organizations (HMOs), and other
health care institutions to provide information
about advance health care directives to
adult patients upon their admission to the
healthcare facility.
• The goals of the "purpose" of the Patient Self-Determination Act
are/were:
1. to prevent Medicare/Medicaid patients for the profit motive cruel
over treatment of elderly/disabled
2. to save money for Medicare and the private insurers
3. It was envisioned by the framers of the 1991 PSDA that the
elderly/disabled on Medicare/Medicaid would die less expensively
and more comfortably (out of pain) on the palliative care/Hospice
Medicare Entitlement in their own personal residence or in the setting of
a residential nursing home
ETHICAL CONSIDERATIONS
• It is known, however, that advance directives (or so called
‘living wills’) pose serious practical and ethical problems
related to continuity, liability, completeness,
interpretation and the relationship between rejected
and demanded medical treatments.
• Many doctors, ethicists, and lawyers presently perceive
advance directives as tools for ensuring autonomy and
enforcing personal wishes regarding medical treatment.
• Majority of the population in many western, highly
industrialized countries does not currently hold an
advance directive
• The few studies done in this field suggest several reasons:
a lack of information regarding the opportunity to create
advance directives, fear of abuse by physicians but also
moral confusion and avoidance of ‘negative thinking’
“LIFE OR DEATH DECISIONS
ARE PERSONAL”
• https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-
depth/living-wills/art-20046303
• https://link.springer.com/article/10.1007/s10728-009-0118-z

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LIFE AND DEATH

JEA JOEL MENDOZA-DUNGCA, RN, MSN

• durable power of attorney for health care or a health care proxy

• The person you name may be a spouse, other family member,

• In determining your wishes, think about your values, such as the

• Mechanical ventilation. Takes over your breathing if

• Antibiotics or antiviral. Medications can be used to treat many

• Organ and tissue donations for transplantation can be specified in

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