GROUP 3 <ul><li>1. Information on the Terri Schaivo Case (Glenn) </li></ul><ul><li>2. Living Wills (Kelly) </li></ul><ul><...
Terri Schiavo Background <ul><li>Born Theresa Marie Schindler on December 03, 1963 in Pennsylvania. </li></ul><ul><li>Her ...
Terri Schiavo Background <ul><li>Terri & Michael were married, at age 20 & 21, in November of 1984. </li></ul><ul><li>Move...
What Happened? <ul><li>Feb 25, 1990: Terri suffers cardiac arrest. </li></ul><ul><li>Brain is damaged due to lack of oxyge...
Love or Money? <ul><li>August 1992: Terri awarded $250,000 in malpractice settlement. </li></ul><ul><li>November 1992: Mic...
The Battle Begins <ul><li>Terri’s parents fight to have Michael removed as guardian. </li></ul><ul><li>Terri’s feeding tub...
Conclusion <ul><li>March 18, 2005:  Feeding tube is removed. </li></ul><ul><li>March 31, 2005:  Terri Schiavo dies at 9:05...
Living Wills <ul><li>A living will states in advance a person's desire to receive, or to withhold, life-support procedures...
Requirements to Create <ul><li>18 years or older </li></ul><ul><li>Must have sound mind </li></ul><ul><li>Must be witnesse...
Application of Living Wills <ul><li>Living wills become applicable when two doctors determine that the patient is in an ir...
Treatments Covered by Living Wills <ul><li>Permits the withholding or withdrawing of life-prolonging treatment that artifi...
Revoking a Living Will <ul><li>Can be revoked at any time by: </li></ul><ul><ul><li>Destroying the document </li></ul></ul...
DNR Order <ul><li>What is it? </li></ul><ul><li>A do not resuscitated order tells doctors, nurses, medical professionals a...
<ul><li>Why are they issued? </li></ul><ul><li>- DNR codes are normally issued when someone is critically or terminally il...
<ul><li>How are they issued? </li></ul><ul><li>-Any adult can write a DNR order for themselves. </li></ul><ul><li>-DNR can...
<ul><li>When you are personally not able to consent to a DNR order who can in your place? </li></ul><ul><li>A close family...
<ul><li>Miscellaneous  </li></ul><ul><li>- Any adult can write a DNR order </li></ul><ul><li>-You can also remove a DNR or...
Power of Attorney for Healthcare <ul><li>You may voluntarily elect a person to make medical care, custody and treatment de...
Your Agent is granted authority over a number of things. <ul><li>Consent to, or refuse to consent to, various medical trea...
The things your agent cannot do by law. <ul><li>Revoking your living will </li></ul><ul><li>May also prohibit authorizing ...
Who may sign a Power of Attorney for Healthcare? <ul><li>Sound Mind </li></ul><ul><li>Age 18 or older </li></ul>
Who may not be a witness. <ul><li>Not related to you by blood, marriage, adoption and not be directly financially responsi...
What happens if the person I appoint dies or is not able to serve as my agent? <ul><li>Successor agents </li></ul>
What happens if I name my spouse as my agent and we are later divorced? <ul><li>The ex-spouse will no longer have the auth...
Will my agent be held liable for my healthcare costs? <ul><li>No </li></ul>
When does it take effect? <ul><li>Finding incapacity by 2 physicians, or one physician and one licensed psychologist </li>...
Can it be revoked? <ul><li>Yes, by… </li></ul><ul><ul><li>Canceling </li></ul></ul><ul><ul><li>Defacing </li></ul></ul><ul...
Steps <ul><li>Let people know your feelings </li></ul><ul><li>Consider the future kinds of treatment decisions </li></ul><...
WI Statutes <ul><li>Declaration to Physicians/ Living Wills  ~  W.S.A. 154 </li></ul><ul><li>DNR  ~  W.S.A. 154 </li></ul>...
Declaration to Physicians/ Living Wills <ul><li>W.S.A. 154.03 </li></ul><ul><ul><li>Must be of sound mind </li></ul></ul><...
Revocation of declaration  <ul><li>W.S.A. 154.05 </li></ul><ul><ul><li>Method </li></ul></ul><ul><ul><ul><li>Physical </li...
Do Not Resuscitate (DNR)  <ul><li>W.S.A. 154.17 (2) </li></ul><ul><li>“ a written order issued under the requirements of t...
Revocation of DNR <ul><li>W.S.A. 154.21 </li></ul><ul><ul><li>Verbally to first respondent </li></ul></ul><ul><ul><li>Phys...
Power of Attorney for Healthcare <ul><li>W.S.A. 155.05 </li></ul><ul><ul><li>Must be of sound mind </li></ul></ul><ul><ul>...
To Revoke Power of  Attorney for Healthcare <ul><li>W.S.A. 155.40 </li></ul><ul><ul><li>a) Physical destruction  </li></ul...
Declarations to Physicians (Living Wills) <ul><li>Definition:  A Declaration to Physicians forms makes it possible for adu...
Definition (cont’d) <ul><li>The withholding or withdrawal of any medication, life-sustaining procedure, or feeding tube ma...
Terminal Illness <ul><li>Definition:  an incurable condition caused by injury or illness that reasonable medical judgment ...
Persistent Vegetative State <ul><li>Definition:  a condition that reasonable medical judgment finds constitutes complete a...
Requirements   <ul><li>2 witnesses are required, must be at least 18 years old, not related by blood, marriage, or adoptio...
Ways to Protect your Declaration to Physician <ul><li>Make friends and relatives aware that you have signed the document a...
Ways to Revoke your Declaration <ul><li>By a written revocation of the declarant expressing the intent to revoke, signed a...
Case Law Spahn v. Eisenberg 563 N.W.2d 485 (Wis. 1997)
Facts of Case <ul><li>Spahn sought remedy from courts because wanted her sister to no longer have nutrients given to her <...
Facts of Case Contin. <ul><li>No advanced directives </li></ul><ul><li>Support system would have been discountinued if all...
Questions for Court <ul><li>Can the guardian of a non-vegetative but incompetent person discontinue support systems? </li>...
Questions for Court <ul><li>Was there sufficient evidence present to conclude that Edna would rather die than live with su...
Reasoning for 1 st  Answer <ul><li>Precedent requires that “clear and convincing” evidence be presented in order to end th...
Reasoning for 1 st  Answer <ul><li>There are four main considerations to which the state must adhere in respects to decisi...
Reasoning for 2nd Answer <ul><li>The only supporting evidence that Edna would not want to live in her current state was ma...
IMPORTANCE!!! <ul><li>The court has created a “bright line” rule stating that incompetent persons may not have life-suppor...
Conditions: <ul><li>The incompetent person is in a permanent vegetative state and doing so is in the person’s best interes...
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Advance Directives

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Advance Directives

  1. 1. GROUP 3 <ul><li>1. Information on the Terri Schaivo Case (Glenn) </li></ul><ul><li>2. Living Wills (Kelly) </li></ul><ul><li>3. DNR Orders (Dave) </li></ul><ul><li>4. Power of Attorney for Healthcare (Heather) </li></ul><ul><li>5. Declarations to Physicians (Jenalee) </li></ul><ul><li>6. Wisconsin Statutes (Mary) </li></ul><ul><li>7. Case Law (Nate) </li></ul>
  2. 2. Terri Schiavo Background <ul><li>Born Theresa Marie Schindler on December 03, 1963 in Pennsylvania. </li></ul><ul><li>Her family consists of her two parents and a brother and sister. </li></ul><ul><li>She met Michael Schiavo at Bucks County Community College. </li></ul>
  3. 3. Terri Schiavo Background <ul><li>Terri & Michael were married, at age 20 & 21, in November of 1984. </li></ul><ul><li>Moved to St. Petersburg, FL with Terri’s parents in 1986. </li></ul><ul><li>Terri & Michael never had children together. </li></ul>
  4. 4. What Happened? <ul><li>Feb 25, 1990: Terri suffers cardiac arrest. </li></ul><ul><li>Brain is damaged due to lack of oxygen. </li></ul><ul><li>June 30, 1990 Court appoints Michael as guardian. </li></ul><ul><li>Allegations that Michael caused Terri’s injury have never been proven true. </li></ul>
  5. 5. Love or Money? <ul><li>August 1992: Terri awarded $250,000 in malpractice settlement. </li></ul><ul><li>November 1992: Michael Schiavo gets $300,000 and $750,000 put in trust for Terri from malpractice trial. </li></ul><ul><li>May 1998: Michael petitions the court to have feeding tube removed. </li></ul>
  6. 6. The Battle Begins <ul><li>Terri’s parents fight to have Michael removed as guardian. </li></ul><ul><li>Terri’s feeding tube removed and reinserted 3 times. </li></ul><ul><li>Politicians get involved. </li></ul><ul><li>Terri’s Law found unconstitutional by the US Supreme Court </li></ul>
  7. 7. Conclusion <ul><li>March 18, 2005: Feeding tube is removed. </li></ul><ul><li>March 31, 2005: Terri Schiavo dies at 9:05 a.m. at age 41. </li></ul><ul><li>An autopsy was performed. </li></ul><ul><li>April 4, 2005: Terri’s body was cremated. </li></ul>
  8. 8. Living Wills <ul><li>A living will states in advance a person's desire to receive, or to withhold, life-support procedures </li></ul><ul><li>It is put into use if someone becomes permanently unconscious or terminally ill and unable to make decisions </li></ul>
  9. 9. Requirements to Create <ul><li>18 years or older </li></ul><ul><li>Must have sound mind </li></ul><ul><li>Must be witnessed by two adults </li></ul>
  10. 10. Application of Living Wills <ul><li>Living wills become applicable when two doctors determine that the patient is in an irreversible coma or unable to make decisions for themselves </li></ul><ul><li>Cannot be used if the person is able to make health care decisions </li></ul>
  11. 11. Treatments Covered by Living Wills <ul><li>Permits the withholding or withdrawing of life-prolonging treatment that artificially extends the dying process. </li></ul><ul><li>Some states allow the removal of artificial nutrition when the patient is in an irreversible coma </li></ul>
  12. 12. Revoking a Living Will <ul><li>Can be revoked at any time by: </li></ul><ul><ul><li>Destroying the document </li></ul></ul><ul><ul><li>Expressing orally to witnesses the desire to revoke </li></ul></ul><ul><ul><li>Written documentation the desire to revoke </li></ul></ul>
  13. 13. DNR Order <ul><li>What is it? </li></ul><ul><li>A do not resuscitated order tells doctors, nurses, medical professionals and EMT’s not to perform CPR on them if they stop breathing or their heart stops </li></ul>
  14. 14. <ul><li>Why are they issued? </li></ul><ul><li>- DNR codes are normally issued when someone is critically or terminally ill because if CPR is performed on them they might still be in a worse state than they were in before CPR was performed. </li></ul><ul><li>ex: brain damage </li></ul>
  15. 15. <ul><li>How are they issued? </li></ul><ul><li>-Any adult can write a DNR order for themselves. </li></ul><ul><li>-DNR can be orally to a doctor or written in a living will with two witnesses present. </li></ul><ul><li>-Doctor must acknowledge you DNR order and if they do not agree with a DNR order they must pass you on to another doctor or try to persuade you the other way before the DNR order comes about. </li></ul><ul><li>-If you cannot decide for yourself, if two doctors agree that CPR would not work they will not perform CPR. </li></ul><ul><li>-A Child DNR order can be issued with the consent of the guardians and if the child is old enough to understand they also have to consent to this decision. </li></ul>
  16. 16. <ul><li>When you are personally not able to consent to a DNR order who can in your place? </li></ul><ul><li>A close family member or close friend when: </li></ul><ul><li>1.you are terminally ill </li></ul><ul><li>2.you are permanently unconscious </li></ul><ul><li>3.CPR will not work </li></ul><ul><li>4.CPR will impose burden on medical conditions </li></ul><ul><li>-but this decision MUST be made on your thoughts of your best interest </li></ul>
  17. 17. <ul><li>Miscellaneous </li></ul><ul><li>- Any adult can write a DNR order </li></ul><ul><li>-You can also remove a DNR order at any time </li></ul><ul><li>-If you are transferred from a hospital to a nursing home or nursing home to home care, etc you have to transfer your DNR and make sure that your doctor is informed of this fact. </li></ul><ul><li>-If CPR is going to be futile for you doctor can forgo CPR but must inform your family and they must agree </li></ul><ul><li>-If family disagrees with the DNR order they will make every way to communicate to patient and family to drop it, but in difficult cases they will normally perform CPR anyways to try to save the patient. </li></ul><ul><li>- Emt will perform CPR even if you have a DNR order </li></ul>
  18. 18. Power of Attorney for Healthcare <ul><li>You may voluntarily elect a person to make medical care, custody and treatment decisions for you if you become unable to express your medical care </li></ul>
  19. 19. Your Agent is granted authority over a number of things. <ul><li>Consent to, or refuse to consent to, various medical treatments </li></ul><ul><li>Access your medical records </li></ul><ul><li>Make arrangements such as at a hospital or nursing home </li></ul><ul><li>Hire and fire your health care providers </li></ul><ul><li>Move you to a different state </li></ul><ul><li>Visit you </li></ul><ul><li>Execute legal documents on health care matters for you </li></ul>
  20. 20. The things your agent cannot do by law. <ul><li>Revoking your living will </li></ul><ul><li>May also prohibit authorizing the withdrawal of life support </li></ul>
  21. 21. Who may sign a Power of Attorney for Healthcare? <ul><li>Sound Mind </li></ul><ul><li>Age 18 or older </li></ul>
  22. 22. Who may not be a witness. <ul><li>Not related to you by blood, marriage, adoption and not be directly financially responsible for your healthcare </li></ul><ul><li>Not a healthcare provider who is serving you at the time the document is singed </li></ul><ul><li>Anyone who has a claim on any portion of your estate </li></ul>
  23. 23. What happens if the person I appoint dies or is not able to serve as my agent? <ul><li>Successor agents </li></ul>
  24. 24. What happens if I name my spouse as my agent and we are later divorced? <ul><li>The ex-spouse will no longer have the authority to act under the healthcare power of attorney </li></ul>
  25. 25. Will my agent be held liable for my healthcare costs? <ul><li>No </li></ul>
  26. 26. When does it take effect? <ul><li>Finding incapacity by 2 physicians, or one physician and one licensed psychologist </li></ul>
  27. 27. Can it be revoked? <ul><li>Yes, by… </li></ul><ul><ul><li>Canceling </li></ul></ul><ul><ul><li>Defacing </li></ul></ul><ul><ul><li>Obliterating </li></ul></ul><ul><ul><li>Burning </li></ul></ul><ul><ul><li>Tearing </li></ul></ul>
  28. 28. Steps <ul><li>Let people know your feelings </li></ul><ul><li>Consider the future kinds of treatment decisions </li></ul><ul><li>Name a person you trust </li></ul><ul><li>Fill out a form </li></ul><ul><li>Make sure you are specific in your wording </li></ul><ul><li>Make it in writing </li></ul><ul><li>Disperse the form </li></ul><ul><li>Make the statement part of your medical record </li></ul>
  29. 29. WI Statutes <ul><li>Declaration to Physicians/ Living Wills ~ W.S.A. 154 </li></ul><ul><li>DNR ~ W.S.A. 154 </li></ul><ul><li>Power of Attorney for Healthcare ~ W.S.A. 155 </li></ul>
  30. 30. Declaration to Physicians/ Living Wills <ul><li>W.S.A. 154.03 </li></ul><ul><ul><li>Must be of sound mind </li></ul></ul><ul><ul><li>18yrs or older </li></ul></ul><ul><ul><li>2 Witnesses </li></ul></ul><ul><ul><ul><li>Who is not eligible? </li></ul></ul></ul><ul><ul><ul><ul><li>Individuals related by blood, marriage or adoption </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Knowledge of declarant’s estate </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Individual in charge of declarants financial healthcare </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Someone who is a healthcare provider: social worker </li></ul></ul></ul></ul>
  31. 31. Revocation of declaration <ul><li>W.S.A. 154.05 </li></ul><ul><ul><li>Method </li></ul></ul><ul><ul><ul><li>Physical </li></ul></ul></ul><ul><ul><ul><li>Written </li></ul></ul></ul><ul><ul><ul><li>Oral </li></ul></ul></ul><ul><ul><ul><li>By executing a subsequent declaration </li></ul></ul></ul><ul><ul><li>Revocation shall be recorded by the physician </li></ul></ul>
  32. 32. Do Not Resuscitate (DNR) <ul><li>W.S.A. 154.17 (2) </li></ul><ul><li>“ a written order issued under the requirements of this subchapter that directs emergency medical technicians, first responders and emergency health care facilities personnel not to attempt cardiopulmonary resuscitation on a person for whom the order is issued if that person suffers cardiac/ respiratory arrest” </li></ul>
  33. 33. Revocation of DNR <ul><li>W.S.A. 154.21 </li></ul><ul><ul><li>Verbally to first respondent </li></ul></ul><ul><ul><li>Physical removal of bracelet: </li></ul></ul><ul><ul><ul><li>defaces, burns or cut off </li></ul></ul></ul>
  34. 34. Power of Attorney for Healthcare <ul><li>W.S.A. 155.05 </li></ul><ul><ul><li>Must be of sound mind </li></ul></ul><ul><ul><li>18yrs or older </li></ul></ul><ul><ul><li>2 Witnesses </li></ul></ul>
  35. 35. To Revoke Power of Attorney for Healthcare <ul><li>W.S.A. 155.40 </li></ul><ul><ul><li>a) Physical destruction </li></ul></ul><ul><ul><li>b) Verbal (presence of 2 witnesses) </li></ul></ul><ul><ul><li>c) Written </li></ul></ul><ul><ul><li>d) Marriage/ divorce </li></ul></ul><ul><ul><li>e) Executing a subsequent power of attorney for health care instrument </li></ul></ul>
  36. 36. Declarations to Physicians (Living Wills) <ul><li>Definition: A Declaration to Physicians forms makes it possible for adults to state their preferences for life-sustaining procedures and feeding tubes in the event the person is in a terminal condition or persistent vegetative state. </li></ul>
  37. 37. Definition (cont’d) <ul><li>The withholding or withdrawal of any medication, life-sustaining procedure, or feeding tube may not be made if the attending physician: </li></ul><ul><li>Advises that doing so will cause pain or reduce comfort. </li></ul><ul><li>The pain or discomfort cannot be alleviated through pain relief measures. </li></ul>
  38. 38. Terminal Illness <ul><li>Definition: an incurable condition caused by injury or illness that reasonable medical judgment finds would cause death imminently, so that the application of life-sustaining procedures serves only to postpone the moment of death. </li></ul>
  39. 39. Persistent Vegetative State <ul><li>Definition: a condition that reasonable medical judgment finds constitutes complete and irreversible loss of all the functions of the cerebral cortex and results in a complete, chronic, and irreversible cessation of all cognitive functioning and consciousness, and a complete lack of behavioral responses that indicate cognitive functioning, although autonomic functions continue. </li></ul>
  40. 40. Requirements <ul><li>2 witnesses are required, must be at least 18 years old, not related by blood, marriage, or adoption, and not directly financially responsible for your health care. </li></ul><ul><li>If unable to sign, the declaration must be signed in the delcarant’s name by one of the witnesses or another person designated by the delcarant. </li></ul><ul><li>Witnesses cannot be persons who know they are entitled to or have a claim on any portion of your estate. </li></ul><ul><li>Witnesses cannot be a health care provider, unless a chaplain, social worker, or employee of an inpatient care facility in which you are a patient. </li></ul>
  41. 41. Ways to Protect your Declaration to Physician <ul><li>Make friends and relatives aware that you have signed the document and where it is kept. </li></ul><ul><li>Keep a signed form in a safe, easily accessible place. </li></ul><ul><li>Notify your attending physician that you have a declaration. </li></ul><ul><li>Make sure the attending physician keeps the document with your medical records </li></ul>
  42. 42. Ways to Revoke your Declaration <ul><li>By a written revocation of the declarant expressing the intent to revoke, signed and dated by the declarant. </li></ul><ul><li>By executing a subsequent declaration. </li></ul><ul><li>By a verbal expression by the declarant of his/her intent to revoke the document. </li></ul><ul><li>By being cancelled, defaced, obliterated, burned, torn, other otherwise destroyed by the declarant or some person who is directed by the declarant. </li></ul>
  43. 43. Case Law Spahn v. Eisenberg 563 N.W.2d 485 (Wis. 1997)
  44. 44. Facts of Case <ul><li>Spahn sought remedy from courts because wanted her sister to no longer have nutrients given to her </li></ul><ul><li>Edna was not categorized as being in a permanent vegatative state. She suffered from dementia but was not expected to improve </li></ul>
  45. 45. Facts of Case Contin. <ul><li>No advanced directives </li></ul><ul><li>Support system would have been discountinued if all family agreed. Niece declined </li></ul><ul><li>Guardian ad litem was appointed during proceeding </li></ul><ul><li>Lower court dismissed case </li></ul>
  46. 46. Questions for Court <ul><li>Can the guardian of a non-vegetative but incompetent person discontinue support systems? </li></ul><ul><li>Answer: NO </li></ul>
  47. 47. Questions for Court <ul><li>Was there sufficient evidence present to conclude that Edna would rather die than live with supports? </li></ul><ul><li>Answer: NO </li></ul>
  48. 48. Reasoning for 1 st Answer <ul><li>Precedent requires that “clear and convincing” evidence be presented in order to end the life of a person who is incompetent </li></ul><ul><li>Precedent states that a competent or incompetent person has the right to refuse medical treatment through advanced directives and other recognized means of refusal and that a legal guardian may carry out those wishes </li></ul>
  49. 49. Reasoning for 1 st Answer <ul><li>There are four main considerations to which the state must adhere in respects to decisions about incompetent persons: </li></ul><ul><li>The preservation of life is the most important factor in the states decision. </li></ul><ul><li>The state must strive to safeguard the integrity of the medical profession. </li></ul><ul><li>The state cannot participate in an act that results in euthanasia. </li></ul><ul><li>The state must attempt to protect innocent third parties. </li></ul>
  50. 50. Reasoning for 2nd Answer <ul><li>The only supporting evidence that Edna would not want to live in her current state was made 30 years prior to this case, during a family crisis. </li></ul><ul><li>The comments that were made did not provide any solid evidence of Edna’s wishes. </li></ul>
  51. 51. IMPORTANCE!!! <ul><li>The court has created a “bright line” rule stating that incompetent persons may not have life-support systems withdrawn unless the following conditions are present: </li></ul>
  52. 52. Conditions: <ul><li>The incompetent person is in a permanent vegetative state and doing so is in the person’s best interest. </li></ul><ul><li>The incompetent person has left advanced directives or </li></ul><ul><li>There is clear and convincing evidence of the incompetents wishes. </li></ul>

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