Core Principles and Legal Myths of End of Life Care

Definition of End of Life Care:

This type of care may be defined as the 30 Multidimensional and multidisciplinary physical, emotional, and spiritual care of the patient with terminal illness, including support of family and caregivers.”

End of life care
Fig: End of life care

In medicine, nursing and the allied health professions, end-of-life care refers to health care, not only of patients in the final hours or days of their lives, but more broadly care of all those with a terminal illness or terminal disease condition that has become advanced, progressive and incurable.

Core Principles for End of Life Care:

  • Be sensitive to and respectful of the patient’s and family’s wishes;
  • Respect the dignity of both patient and caregivers;
  • Assess and manage psychological, social, and spiritual/religious problems;
  • Provide access to palliative care and hospice care;
  • Offer continuity (the patient should be able to continue to be cared for, if so desired, by his/her primary care and specialist providers);
  • Use the most appropriate measures that are consistent with patient choices,
  • Encompass alleviation of pain and other physical symptoms;
  • Provide access to any therapy which may realistically be expected to improve the patient’s quality of life, including alternative or nontraditional treatments;
  • Respect the physician’s professional responsibility to discontinue some treatments when appropriate, with consideration for both patient and family preferences;
  • Promote clinical and evidence-based research on providing care at the end of life;
  • Respect the right to refuse treatment.

7 Major Legal Myths Regarding End of Life Care:

The 7 major legal myths regarding end of life care are:

  1. Forgoing life-sustaining treatment for patients without decision making capacity requires evidence that this was the patient’s actual wish;
  2. Withholding or withdrawing of artificial fluids and nutrition from terminally ill or permanently unconscious patients is illegal;
  3. Risk management personnel must be consulted before life-sustaining medical treatment may be terminated;
  4. Advance directives must comply with specific forms, are not transferable between states, and govern all future treatment decisions; oral advance directives are unenforceable;
  5. If a physician prescribes or administers high doses of medication to relieve pain or other discomfort in a terminally ill patient, resulting in death, he/she will be criminally prosecuted;
  6. When a terminally ill patient’s suffering is overwhelming despite palliative care, and he/she requests a hastened death, there are no legally permissible options to ease suffering; and
  7. The 1997 Supreme Court decisions outlawed physician-assisted suicide. Many legal barriers to this type of care are more mythical than real, but sometimes there is a grain of truth. Physicians must know the law of the state in which they practice.

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