wills trust chap 6

Introduction

  • Today's discussion focuses on Chapter Six of the course material.

  • Emphasizes the upcoming quiz on Friday, covering the first four chapters.

Overview of Chapter Six

  • Topic: Advanced Directives

  • Objectives:

    • Explain the history of the right to die.

    • Discuss what advanced directives are.

    • Describe the purpose of living wills and Do Not Resuscitate (DNR) orders.

The Right to Die

  • Involves significant legal discussions and case laws.

  • Three main cases that shape the debate of the right to die:

    1. Karen Quinlan Case:

    • Karen Quinlan was in a permanent coma and kept alive on a ventilator.

    • Her parents requested to remove life support.

    • Outcome: New Jersey Supreme Court ruled individuals have a right to refuse life-prolonging treatment, affirming the role of families in making medical decisions for incapacitated loved ones.

    1. Nancy Cruzan Case:

    • Nancy was in a persistent vegetative state after a car accident.

    • Her parents sought to remove her feeding tube.

    • Outcome: US Supreme Court allowed states to require clear evidence of patient wishes before stopping life-sustaining treatment.

    • Additional evidence of Nancy's wishes was later presented, leading to the court allowing removal of the feeding tube.

    1. Terri Schindler Schiavo Case:

    • Terri was in a long-term vegetative state, and her husband wanted to remove her feeding tube, while her parents opposed.

    • Outcome: After lengthy legal battles, the court sided with her husband, who was designated as her legal guardian.

    • Highlights the conflict that can arise between spouses and parents regarding end-of-life decisions.

Importance of Advance Directives

  • Advance directives outline individuals' healthcare preferences in case they become incapacitated.

  • Types include:

    • Living Wills: Specify what life-sustaining treatments a person does or does not want.

    • Healthcare Proxies or Surrogates: Appoint someone to make medical decisions on the individual’s behalf.

    • Durable Power of Attorney for Healthcare: Grants someone legal authority to act in medical matters.

    • DNR Orders: Direct doctors not to perform CPR if the heart stops.

    • Anatomical Gifts: Allow for organ or tissue donation after death.

    • Physician Orders for Life-Sustaining Treatment (POLST): Detailed medical orders for seriously ill patients.

Living Wills

  • Definition: Legal document directing refusal of treatment in terminal conditions.

  • Prolonging procedures exclude those solely providing comfort.

  • A terminal condition is characterized by:

    • Absence of voluntary action or cognitive behavior.

    • No reasonable possibility of recovery.

Relevant Texas Legislation

  • Texas Advanced Directives Act

    • Defines life-prolonging procedures, which include artificial support mechanisms like ventilators and feeding tubes.

    • Comfort care must always be provided, including pain relief, regardless of directives.

    • Irreversible condition: No chance for recovery; for example, a patient on a ventilator with no hope of recovery based on medical evaluation.

The Role of Advance Directives in Medical Settings

  • Protects patients' wishes and minimizes family conflict during medical crises.

  • Effective documents reduce stress by clarifying healthcare preferences to avoid disputes at critical moments.

  • Commonly included in medical paperwork at hospitals during treatment initiation.

Requirements for a Valid Living Will

  • Must include:

    • Personal Information: Details of the declarant (the person creating the will).

    • Intent: Clear statement that the decision is made voluntarily and deliberately.

    • Medical Conditions: Scenarios that trigger the refusal of treatment.

    • Pregnancy Clause: A specification that the directive may not apply to pregnant individuals.

    • Liability Clause: Protects healthcare providers who follow the directive from legal consequences.

    • Signature Requirements: Must be signed and witnessed to be legally binding.

Health Insurance Portability and Accountability Act (HIPAA)

  • Stipulates patients' health record privacy.

  • Requires written authorization before any medical records can be shared or accessed.

  • Particularly relevant in personal injury cases.

Do Not Resuscitate (DNR) Orders

  • Definition: Specific advanced directives for terminally ill patients.

  • Must be completed according to state laws to be valid.

  • DNR indicates that no CPR or resuscitation will be performed if breathing or heart function ceases.

  • In Texas:

    • DNR forms must be on official state paper and may use distinct colors (e.g., yellow).

    • Valid only if signed at a healthcare facility.

Healthcare Surrogates

  • Definition: Individuals appointed to make medical decisions on behalf of someone unable to speak for themselves.

  • Requirements:

    • Must be in writing and signed by at least two witnesses.

    • Should not have conflicting financial interests.

  • Limitations on their authority:

    • Cannot consent to abortions, sterilizations, shock therapy, or non-FDA approved experimental treatments.

Medical Power of Attorney

  • Allows an appointed agent to make healthcare decisions when the principal is incapacitated.

  • Becomes effective only when the principal loses the ability to make their own decisions.

  • Cannot authorize actions beyond medical treatment without explicit power granted in the document.

Differences Between Durable Power of Attorney and Medical Power of Attorney

  • Durable Power of Attorney: Remains valid even if the principal becomes incapacitated, dealing with both financial and legal matters.

  • Medical Power of Attorney: Restricted solely to medical decisions and only becomes effective upon incapacitation.

Physician Orders for Life-Sustaining Treatment (POLST)

  • POLST is a physician's order specifying patient preferences for life-sustaining treatment across healthcare settings.

  • Unlike living wills, POLST orders must be adhered to immediately by medical personnel.

Death with Dignity Laws

  • These laws enable terminally ill patients to choose to end their lives with prescribed medication.

  • Oregon was the first to enact such laws; several other states have followed.

  • Texas Law: Does not permit assisted suicide or similar practices; considered illegal under Texas Penal Code 22.208.

Anatomical Gifts

  • Anatomical gifts refer to organ and tissue donations after death.

  • Ways to become a donor include:

    • Stating wishes in a will (not the most effective due to timing).

    • Signing a donor card or registering online.

    • Indicating donation preferences on a driver’s license.

  • Legislation: Under Texas law, family members may authorize donations if no prior directives exist.

Conclusion

  • Stress on the importance of having clear advanced directives in place to ensure personal wishes are honored and reduce potential conflicts among family members during critical medical situations.

  • Encouragement to complete advance directives proactively to safeguard against future dilemmas regarding health care decisions.