This document discusses end-of-life issues from legal and bioethics perspectives. It provides an overview of dying in America, including statistics on causes of death and locations of death. It discusses American attitudes toward death and key cases establishing the right to refuse life-sustaining treatment, including Cruzan v. Missouri Department of Health and In Re Quinlan. It also discusses the contemporary case of Theresa Schiavo, who was in a persistent vegetative state and at the center of a legal battle over removal of her feeding tube.
RESEARCH METHODOLOGY AND BIOSTATISTICS : UNIT-IV: Medical fatality iASHISHSUTTEE
Case fatality rate, also called case fatality risk or case fatality ratio, in epidemiology, the proportion of people who die from a specified disease among all individuals diagnosed with the disease over a certain period of time.
RESEARCH METHODOLOGY AND BIOSTATISTICS : UNIT-IV: Medical fatality iASHISHSUTTEE
Case fatality rate, also called case fatality risk or case fatality ratio, in epidemiology, the proportion of people who die from a specified disease among all individuals diagnosed with the disease over a certain period of time.
Read the Case Law and answer the questions.Instructions.docxveachflossie
Read the Case Law and answer the questions.
Instructions:
Read the
Case Law - Werth vs. Taylor
(See Below)
Then, answer the questions below.
Did this case turn out the way you thought it would? Why or why not?
How could Cindy have assured herself that she would not receive any blood no matter what happened?
Would it have made any difference in the outcome of the case if the anesthesiologist had interviewed Cindy before the procedure and told her that her life could be in danger if she refused blood during both procedures?
What kind of consent is it when there is an emergency situation and the physician/healthcare worker needs to act or the patient may lose their life?
Your paper should be:
One (1) page
Typed according to APA style for margins, formatting and spacing standards
Typed into a Microsoft Word document, save the file, and then upload the file
CASE LAW
Case Law Werth vs. Taylor 475 N.W.2d 426, 427 (Mich. Ct. App. 1991) Cindy Werth was expecting twins. Because she was a Jehovah’s Witness and had a firm belief in the religion’s teaching “that it is a sin to receive blood transfusions”, Cindy signed a “Refusal to Permit Blood Transfusions” form as part of her hospital preregistration. After delivery, Cindy had complications and was experiencing uterine bleeding. She was advised to undergo a dilatation and curettage and agreed. Again, she discussed her refusal to allow a blood transfusion with her obstetrician/gynecologist (OB/Gyn). After being placed under anesthesia and despite the specialist’s efforts during surgery, Cindy continued to bleed and was experiencing, among other things, premature ventricular activity and a significant decrease in blood pressure. The anesthesiologist (Dr. Michael Taylor) determined that Cindy needed a blood transfusion to sustain her life. Cindy’s OB/Gyn expressed Cindy’s refusal of blood transfusions, but the anesthesiologist proceeded anyway stating that it was medically necessary. The Werth’s filed a malpractice suit, alleging that Dr. Taylor committed battery by performing the transfusion without Cindy’s consent. Dr. Taylor moved for a summary disposition “because Cindy’s refusal was not conscious, competent, contemporaneous and fully informed.” The trial court found that Cindy’s refusals of a transfusion were made when she contemplated “merely routine elective surgery” and not life-threatening circumstances, and that, “it could not be said that she made the decision to refuse a blood transfusion while in a competent state and while fully aware that death would result from such refusal.” The record apparently reflected “the unexpected development of a medical emergency requiring blood transfusion to prevent death or serious compromise of the patient’s wellbeing.”
...
Understanding Death with Dignity Legislation: A Necessity for the Palliative ...wwuextendeded
Understanding Death with Dignity Legislation: A Necessity for the Palliative Care Provider - Frances DeRook, MD, FACC
Presented at the 2015 Palliative Care Summer Institute conference at Bellingham Technical College
n engl j med 352;16www.nejm.org april 21, .docxgilpinleeanna
n engl j med
352;16
www.nejm.org april
21, 2005
1630
P E R S P E C T I V E
verse populations and less inclusive health care pro-
grams, cautioned Joanne Lynn, a senior research-
er with the RAND Corporation and director of the
Washington Home Center for Palliative Care Stud-
ies in Washington, D.C. “There isn’t a huge demand
for assisted suicide in good care systems, but there
could be a huge demand in much less adequate care
systems,” Lynn said.
Psychiatrist Linda Ganzini of Oregon Health and
Sciences University agrees that her state’s high-
quality system of palliative care is the factor most
responsible for keeping the number of assisted-sui-
cide cases low. “Your safety net is your end-of-life
care and your hospice care,” she said. “It’s not the
safeguards that you build into the law.”
1.
Colburn D. Why am I not dead? The Oregonian. March 4,
2005:A01.
2.
Tolle SW, Tilden VR, Drach LL, Fromme EK, Perrin NA, Hedberg
K. Characteristics and proportion of dying Oregonians who person-
ally consider physician-assisted suicide. J Clin Ethics 2004;15:111-8.
3.
Ganzini L, Nelson HD, Lee MA, Kraemer DF, Schmidt TA,
Delorit MA. Oregon physicians’ attitudes about and experiences
with end-of-life care since passage of the Oregon Death with Dig-
nity Act. JAMA 2001;285:2363-9.
4.
House of Lords Select Committee on the Assisted Dying for
the Terminally Ill Bill. Volume I: Report. HL Paper 86-I.
The story of Terri Schiavo should be disturbing to
all of us. How can it be that medicine, ethics, law,
and family could work so poorly together in meet-
ing the needs of this woman who was left in a per-
sistent vegetative state after having a cardiac ar-
rest? Ms. Schiavo had been sustained by artificial
hydration and nutrition through a feeding tube
for 15 years, and her husband, Michael Schiavo, was
locked in a very public legal struggle with her par-
ents and siblings about whether such treatment
should be continued or stopped. Distortion by inter-
est groups, media hyperbole, and manipulative use
of videotape characterized this case and demon-
strate what can happen when a patient becomes
more a precedent-setting symbol than a unique hu-
man being.
Let us begin with some medical facts. On Feb-
ruary 25, 1990, Terri Schiavo had a cardiac arrest,
triggered by extreme hypokalemia brought on by an
eating disorder. As a result, severe hypoxic–ische-
mic encephalopathy developed, and during the sub-
sequent months, she exhibited no evidence of high-
er cortical function. Computed tomographic scans
of her brain eventually showed severe atrophy of
her cerebral hemispheres, and her electroenceph-
alograms were flat, indicating no functional activ-
ity of the cerebral cortex. Her neurologic examina-
tions were indicative of a persistent vegetative state,
which includes periods of wakefulness alternating
with sleep, some reflexive responses to light and
noise, and some basic gag and swallowing respons-
es, but no signs of emotion, wi ...
Chapter 17End-of-Life IssuesWhen we finally know we are EstelaJeffery653
Chapter 17
End-of-Life Issues
When we finally know we are dying,
And all other sentient beings are dying with us,
We start to have a burning,
almost heart-breaking sense
of the fragility and preciousness of each moment and each being,
and from this can grow
a deep, clear, limitless compassion for all beings.
—Sogyal Rinpoche
Learning Objectives
Discuss the human struggle to survive and the right to autonomous decision making.
Describe how patient autonomy has been impacted by case law and legislative enactments.
Discuss the following concepts: preservation of life with limits, euthanasia, advance directives, futility of treatment, withholding and withdrawal of treatment, and do-not-resuscitate orders.
Learning Objectives, cont’d
Explain end-of-life issues as they relate to autopsy, organ donations, research, experimentation, and clinical trials.
Describe how human genetics and stem cell research can have an impact on end-of-life issues.
Dreams of Immortality
Human Struggle to Survive
Desire to Prevent & Cure Illness
Advances in Medicine & Power to Prolong Life
Ethical & Legal Issues
Involving entire life span
From right to be born to right to die
Patient Autonomy
Right to make one’s own decisions
Patient has the right to accept or refuse care even if it is beneficial to saving his or her life.
Autonomy may be inapplicable in certain cases.
Affected by one’s disabilities, mental status, maturity, or incapacity to make decisions
No right is held more sacred, or is more carefully guarded, by the common law, than the right of every individual to the possession and control of his own person, free from all restraint or interference of others, unless by clear and unquestioned authority of law.
—Union Pac. Ry. Co. v. Botsford (1891)
Every human being of adult years and sound mind has a right to determine what shall be done with his own body and a surgeon who performs an operation without his patient’s consent commits an assault, for which he is liable in damages, except in cases of emergency where the patient is unconscious and where it is necessary to operate before consent can be obtained.
—Schloendorff v. Society of New York Hospital (1914)
Why Courts Get Involved
End-of-Life Issues
Family members disagree as to the incompetent’s wishes.
Physicians disagree on the prognosis.
A patient’s wishes are unknown because he or she has always been incompetent.
Evidence exists of wrongful motives or malpractice.
In re Quinlan (1976)
Constitutional right to privacy protects patient’s right to self-determination.
A state’s interest does not justify interference with one’s right to refuse treatment.
In re Storar (1981)
Every human being of adult years and sound mind has the right to determine what shall be done with his or her own body.
Superintendent of Belchertown State School v. Saikewicz (1977)
Saikewicz allowed to refuse treatment.
Questions of life and death with regard to an incompetent ...
this is a discussion not a paper I need a paragraph under each quest.docxabhi353063
this is a discussion not a paper I need a paragraph under each question. each paragraph need to be at least 250 words with up to date references.
HAS 515 Week 8 Lecture:
Patient Rights and Responsibilities and Acquired Immunodeficiency Syndrome
Slide #
Scene/Interaction
Narration
Slide 1
Intro Slide
Slide 2
Scene 1
Professor Charles enters classroom and introduces the topics for today’s lesson and begins the lecture.
Prof Charles
: Hello everyone….welcome back to class. Today, we are going to discuss patient rights and responsibilities and acquired immunodeficiency syndrome.
The Patient Self-Determination Act of 1990 (PSDA) made a significant advance in the protection of the rights of patients to make decisions regarding their own health care. Healthcare organizations may no longer passively permit patients to exercise their rights but must protect and promote such rights. The PSDA provides that each individual has a right under state law to make decisions concerning his or her medical care, including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives.
Let’s first discuss the rights of the patient. How are patient rights classified?
Casey:
Patient rights may be classified as either legal (those emanating from law) or human statements of desirable ethical principles (such as the right to healthcare or the right to be treated with human dignity). Both staff and patients should be aware and understand not only their own rights and responsibilities, but also the rights and responsibilities of each other.
Donald
: Patients also have a right to receive a clear explanation of tests, diagnoses, treatment options, prescribed medications, and prognosis; participate in healthcare decisions; understand treatment options; and discontinue or refuse treatment options. It is recognized that the relationship between the physician and the patient is essential for the provision of proper care.
Casey
: In addition to what has already been noted, I would say that legal precedent has established that not only does the institution have responsibility to the patient, but also the patient has responsibility to the institution.
Prof. Charles
: Absolutely… What does the federal and state law and the Constitution have to say about discriminatory practices?
Casey
: Most federal, state and local programs specifically require, as a condition for receiving funds under such programs, an affirmative statement on the part of the organization that it will not discriminate. For example, Medicare and Medicaid programs specifically require affirmative assurances by healthcare organizations that no discrimination will be practiced. Healthcare organizations who do not comply may lose Medicare and Medicaid certification and reimbursement.
Prof. Charles
: Excellent. What is an example of discrimination by a hospital?
Donald:
There was a case,
Stoick v. Caro Community Hospital
, where the patient brought a medical ...
Read the Case Law and answer the questions.Instructions.docxveachflossie
Read the Case Law and answer the questions.
Instructions:
Read the
Case Law - Werth vs. Taylor
(See Below)
Then, answer the questions below.
Did this case turn out the way you thought it would? Why or why not?
How could Cindy have assured herself that she would not receive any blood no matter what happened?
Would it have made any difference in the outcome of the case if the anesthesiologist had interviewed Cindy before the procedure and told her that her life could be in danger if she refused blood during both procedures?
What kind of consent is it when there is an emergency situation and the physician/healthcare worker needs to act or the patient may lose their life?
Your paper should be:
One (1) page
Typed according to APA style for margins, formatting and spacing standards
Typed into a Microsoft Word document, save the file, and then upload the file
CASE LAW
Case Law Werth vs. Taylor 475 N.W.2d 426, 427 (Mich. Ct. App. 1991) Cindy Werth was expecting twins. Because she was a Jehovah’s Witness and had a firm belief in the religion’s teaching “that it is a sin to receive blood transfusions”, Cindy signed a “Refusal to Permit Blood Transfusions” form as part of her hospital preregistration. After delivery, Cindy had complications and was experiencing uterine bleeding. She was advised to undergo a dilatation and curettage and agreed. Again, she discussed her refusal to allow a blood transfusion with her obstetrician/gynecologist (OB/Gyn). After being placed under anesthesia and despite the specialist’s efforts during surgery, Cindy continued to bleed and was experiencing, among other things, premature ventricular activity and a significant decrease in blood pressure. The anesthesiologist (Dr. Michael Taylor) determined that Cindy needed a blood transfusion to sustain her life. Cindy’s OB/Gyn expressed Cindy’s refusal of blood transfusions, but the anesthesiologist proceeded anyway stating that it was medically necessary. The Werth’s filed a malpractice suit, alleging that Dr. Taylor committed battery by performing the transfusion without Cindy’s consent. Dr. Taylor moved for a summary disposition “because Cindy’s refusal was not conscious, competent, contemporaneous and fully informed.” The trial court found that Cindy’s refusals of a transfusion were made when she contemplated “merely routine elective surgery” and not life-threatening circumstances, and that, “it could not be said that she made the decision to refuse a blood transfusion while in a competent state and while fully aware that death would result from such refusal.” The record apparently reflected “the unexpected development of a medical emergency requiring blood transfusion to prevent death or serious compromise of the patient’s wellbeing.”
...
Understanding Death with Dignity Legislation: A Necessity for the Palliative ...wwuextendeded
Understanding Death with Dignity Legislation: A Necessity for the Palliative Care Provider - Frances DeRook, MD, FACC
Presented at the 2015 Palliative Care Summer Institute conference at Bellingham Technical College
n engl j med 352;16www.nejm.org april 21, .docxgilpinleeanna
n engl j med
352;16
www.nejm.org april
21, 2005
1630
P E R S P E C T I V E
verse populations and less inclusive health care pro-
grams, cautioned Joanne Lynn, a senior research-
er with the RAND Corporation and director of the
Washington Home Center for Palliative Care Stud-
ies in Washington, D.C. “There isn’t a huge demand
for assisted suicide in good care systems, but there
could be a huge demand in much less adequate care
systems,” Lynn said.
Psychiatrist Linda Ganzini of Oregon Health and
Sciences University agrees that her state’s high-
quality system of palliative care is the factor most
responsible for keeping the number of assisted-sui-
cide cases low. “Your safety net is your end-of-life
care and your hospice care,” she said. “It’s not the
safeguards that you build into the law.”
1.
Colburn D. Why am I not dead? The Oregonian. March 4,
2005:A01.
2.
Tolle SW, Tilden VR, Drach LL, Fromme EK, Perrin NA, Hedberg
K. Characteristics and proportion of dying Oregonians who person-
ally consider physician-assisted suicide. J Clin Ethics 2004;15:111-8.
3.
Ganzini L, Nelson HD, Lee MA, Kraemer DF, Schmidt TA,
Delorit MA. Oregon physicians’ attitudes about and experiences
with end-of-life care since passage of the Oregon Death with Dig-
nity Act. JAMA 2001;285:2363-9.
4.
House of Lords Select Committee on the Assisted Dying for
the Terminally Ill Bill. Volume I: Report. HL Paper 86-I.
The story of Terri Schiavo should be disturbing to
all of us. How can it be that medicine, ethics, law,
and family could work so poorly together in meet-
ing the needs of this woman who was left in a per-
sistent vegetative state after having a cardiac ar-
rest? Ms. Schiavo had been sustained by artificial
hydration and nutrition through a feeding tube
for 15 years, and her husband, Michael Schiavo, was
locked in a very public legal struggle with her par-
ents and siblings about whether such treatment
should be continued or stopped. Distortion by inter-
est groups, media hyperbole, and manipulative use
of videotape characterized this case and demon-
strate what can happen when a patient becomes
more a precedent-setting symbol than a unique hu-
man being.
Let us begin with some medical facts. On Feb-
ruary 25, 1990, Terri Schiavo had a cardiac arrest,
triggered by extreme hypokalemia brought on by an
eating disorder. As a result, severe hypoxic–ische-
mic encephalopathy developed, and during the sub-
sequent months, she exhibited no evidence of high-
er cortical function. Computed tomographic scans
of her brain eventually showed severe atrophy of
her cerebral hemispheres, and her electroenceph-
alograms were flat, indicating no functional activ-
ity of the cerebral cortex. Her neurologic examina-
tions were indicative of a persistent vegetative state,
which includes periods of wakefulness alternating
with sleep, some reflexive responses to light and
noise, and some basic gag and swallowing respons-
es, but no signs of emotion, wi ...
Chapter 17End-of-Life IssuesWhen we finally know we are EstelaJeffery653
Chapter 17
End-of-Life Issues
When we finally know we are dying,
And all other sentient beings are dying with us,
We start to have a burning,
almost heart-breaking sense
of the fragility and preciousness of each moment and each being,
and from this can grow
a deep, clear, limitless compassion for all beings.
—Sogyal Rinpoche
Learning Objectives
Discuss the human struggle to survive and the right to autonomous decision making.
Describe how patient autonomy has been impacted by case law and legislative enactments.
Discuss the following concepts: preservation of life with limits, euthanasia, advance directives, futility of treatment, withholding and withdrawal of treatment, and do-not-resuscitate orders.
Learning Objectives, cont’d
Explain end-of-life issues as they relate to autopsy, organ donations, research, experimentation, and clinical trials.
Describe how human genetics and stem cell research can have an impact on end-of-life issues.
Dreams of Immortality
Human Struggle to Survive
Desire to Prevent & Cure Illness
Advances in Medicine & Power to Prolong Life
Ethical & Legal Issues
Involving entire life span
From right to be born to right to die
Patient Autonomy
Right to make one’s own decisions
Patient has the right to accept or refuse care even if it is beneficial to saving his or her life.
Autonomy may be inapplicable in certain cases.
Affected by one’s disabilities, mental status, maturity, or incapacity to make decisions
No right is held more sacred, or is more carefully guarded, by the common law, than the right of every individual to the possession and control of his own person, free from all restraint or interference of others, unless by clear and unquestioned authority of law.
—Union Pac. Ry. Co. v. Botsford (1891)
Every human being of adult years and sound mind has a right to determine what shall be done with his own body and a surgeon who performs an operation without his patient’s consent commits an assault, for which he is liable in damages, except in cases of emergency where the patient is unconscious and where it is necessary to operate before consent can be obtained.
—Schloendorff v. Society of New York Hospital (1914)
Why Courts Get Involved
End-of-Life Issues
Family members disagree as to the incompetent’s wishes.
Physicians disagree on the prognosis.
A patient’s wishes are unknown because he or she has always been incompetent.
Evidence exists of wrongful motives or malpractice.
In re Quinlan (1976)
Constitutional right to privacy protects patient’s right to self-determination.
A state’s interest does not justify interference with one’s right to refuse treatment.
In re Storar (1981)
Every human being of adult years and sound mind has the right to determine what shall be done with his or her own body.
Superintendent of Belchertown State School v. Saikewicz (1977)
Saikewicz allowed to refuse treatment.
Questions of life and death with regard to an incompetent ...
this is a discussion not a paper I need a paragraph under each quest.docxabhi353063
this is a discussion not a paper I need a paragraph under each question. each paragraph need to be at least 250 words with up to date references.
HAS 515 Week 8 Lecture:
Patient Rights and Responsibilities and Acquired Immunodeficiency Syndrome
Slide #
Scene/Interaction
Narration
Slide 1
Intro Slide
Slide 2
Scene 1
Professor Charles enters classroom and introduces the topics for today’s lesson and begins the lecture.
Prof Charles
: Hello everyone….welcome back to class. Today, we are going to discuss patient rights and responsibilities and acquired immunodeficiency syndrome.
The Patient Self-Determination Act of 1990 (PSDA) made a significant advance in the protection of the rights of patients to make decisions regarding their own health care. Healthcare organizations may no longer passively permit patients to exercise their rights but must protect and promote such rights. The PSDA provides that each individual has a right under state law to make decisions concerning his or her medical care, including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives.
Let’s first discuss the rights of the patient. How are patient rights classified?
Casey:
Patient rights may be classified as either legal (those emanating from law) or human statements of desirable ethical principles (such as the right to healthcare or the right to be treated with human dignity). Both staff and patients should be aware and understand not only their own rights and responsibilities, but also the rights and responsibilities of each other.
Donald
: Patients also have a right to receive a clear explanation of tests, diagnoses, treatment options, prescribed medications, and prognosis; participate in healthcare decisions; understand treatment options; and discontinue or refuse treatment options. It is recognized that the relationship between the physician and the patient is essential for the provision of proper care.
Casey
: In addition to what has already been noted, I would say that legal precedent has established that not only does the institution have responsibility to the patient, but also the patient has responsibility to the institution.
Prof. Charles
: Absolutely… What does the federal and state law and the Constitution have to say about discriminatory practices?
Casey
: Most federal, state and local programs specifically require, as a condition for receiving funds under such programs, an affirmative statement on the part of the organization that it will not discriminate. For example, Medicare and Medicaid programs specifically require affirmative assurances by healthcare organizations that no discrimination will be practiced. Healthcare organizations who do not comply may lose Medicare and Medicaid certification and reimbursement.
Prof. Charles
: Excellent. What is an example of discrimination by a hospital?
Donald:
There was a case,
Stoick v. Caro Community Hospital
, where the patient brought a medical ...