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Modules:

  • Introduction
  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological
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    Legal Issues

    Law and Ethics

    Law and Ethics

    United States Law

    • Two systems—federal and state
    • Lawmakers
      • judges (common law)
      • legislatures (statutory law)
      • executive agencies empowered by legislatures (regulatory law)
    • Enforcement through
      • administrative system (licensure suspension or revocation)

      • the civil system (most commonly, monetary judgments, but in the medical context, often an order to take an action or to stop treatment, known as "declaratory or injunctive relief")

      • the criminal system (fines and/or prison)
    • End-of-life issues generally addressed through
      • civil common law (federal or state)
      • statutory law (usually state)
    • Although many important legal principles in end-of-life decision-making are widely accepted among the states, it is important for physicians to become familiar with their state’s specific statutes and cases.

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    Resolving Difficult Cases: Role of Law and Ethics

    • In any discussion of ethical issues in medicine, legal issues may arise
    • Both ethics and the law set norms or standards for conduct
    • Law
      • The law often expresses a kind of minimal ethical societal consensus—one that society is willing to enforce through civil judgments or criminal sanctions

      • However, there are areas of conduct that the law does not and cannot address

      • Slow and expensive means of dispute resolution

      • Going to court rarely necessary in end of life situations
    • Ethics committees/consultants
      • Clinicians facing difficult decisions concerning patients near the end of life may be aided by consultation with ethics consultants and ethics committees

      • Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) mandates this mechanism to address ethical issues

      • Most health care institutions have ethics consultants or have established ethics committees

      • Role of ethics committees and consultants

        • Develop processes to allow clinicians, patients, and families a forum for the discussion of end-of-life decision-making

        • Provide a mechanism to consider recommendations regarding ethically appropriate choices in a given situation
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