Maximizing End-of Life Decisions: at an imperfect time in an imperfect World Nuances, Confusion & Misinformation DNR Family 5 Wishes Guardianship HCP Guilt DNI AND Communication Compassionate Choices Advance Directive Living Will DPOA Child New England Home Care & Hospice May 20, 2015 Parent DNH POLST Comfort Care Spouse MOLST Conservatorship 2015 Stephen Spano, BA, MBA, JD, CELA Spano & Dawicki 1-855-Caring-Law (1-855-227-4645) help@spanodawicki.com Wishing Will Not Solve Anything Where Do You Want To Live? 1
P/M/C OLST Orders on Life Sustaining Treatment. An OLST form may be used in addition to or as a replacement for a DNR order Must be signed by patient/authorized agent and doctor, advanced practice registered nurse, or physician assistant depending upon your state Addresses life-sustaining measures in addition to CPR, such as intubation, antibiotic use, and feeding tubes. Provides your wishes at a glance, but it is not a substitute for a properly prepared advance directive Advance directive can provide more information than a OLST form, including details about your health care agent, more complete health care wishes, and your preference for organ donation. POLST - NH Provider Orders on Life Sustaining Treatment. http://www.healthynh.com/index.php/provid er-orders-for-life-sustaining-treatmentpolst.html POLST - ME Physician Orders on Life Sustaining Treatment http://polstmaine.org 2
COLST - VT Clinical Orders on Life Sustaining Treatment http://www.vtethicsnetwork.org/colst.html MOLST - MA MOLST Medical Orders on Life Sustaining Treatment http://molst-ma.org/ MOLST - RI Medical Orders on Life Sustaining Treatment http://www.health.ri.gov/lifestages/death/ab out/medicalordersforlifesustainingtreatment / 3
POLST - CT In demonstration project stage https://www.ctendoflifecare.org/what-ismolst.html 4
In The End Health Care Proxy End of Life Decisions MGL 201D 5 Section 5. An agent shall have the authority to make any and all health care decisions on the principal s behalf that the principal could make, including decisions about life-sustaining treatment, subject, however, to any express limitations in the health care proxy. 5
Difficult Choices Durable Power of Attorney End of Life Decisions MGL 190B 5-501 In Massachusetts, the DPA/DPOA is a financial document, not a healthcare document Some states use the term "Medical Durable Power of Attorney" or "Healthcare Durable Power of Attorney" In those cases, if the document complies with the laws of the state were it was drafted, it will be normally be honored by the current state Guardianship End of Life Decisions MGL 190B Article V Person appointed by the court to make physical, health, safety, self-care and personal care decisions for the incapacity person No explicit EOL authority If a pre-incapacity HCP exists it may provide guidance Seek court authorization for withholding treatment decisions, executing a DNR, DNI or other substituted judgment decisions 6
Conservatorship End of Life Decisions MGL 190B Article V No EOL authority as the conservator is the person appointed by the court to manage the estate of the protected person NOT the person appointed by the court to make physical, health, safety, self-care and personal care decisions for the protected person If a pre-incapacity DPOA exists, it may provide financial guidance Five Wishes & Caring Conversations May serve as a HCP if properly executed May provide guidance May ease guilt May minimize family conflict CC more sectarian, 5W more religious https://www.agingwithdignity.org/fivewishes.php http://www.midbio.org/workbook.pdf DNR / AND DNR - Do Not Resuscitate AND Allow Natural Death AND is DNR properly stated Language is Key Life Sustaining vs. Death Prolonging http://www.mass.gov/eohhs/docs/dph/emer gency-services/comfort-care-form.pdf 7
What if No Advance Planning Recess The End Spano & Dawicki Stephen J. Spano, MBA, JD, CELA Boston, Beverly, Saugus & Woburn 1-855-Caring-Law 1-855-227-4645 8