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  • 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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  • Clergy and Faith Communities
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    Legal Issues

    Role of Professional and Institutional Counsel
    • Physicians have responsibility to make ethical decisions in the care of patients at the end of life within the law that governs their medical practice
      • While ethics committees and consultation may consider legal aspects

      • Ethics committees do not act as legal advisor to physician and should not be mistaken as such
    • Broad legal consensus on much of end-of-life treatment
      • Some state variations remain (e.g., standards of certainty that surrogates must demonstrate in making decisions)

      • Some difficult legal issues remain unresolved (e.g., futility)
    • In addition, if the physician works in a managed care organization that has set limits on care that the patient or family disagrees with
      • Physician may have to choose to advocate for one party over the other

      • Physician may also face incentives and disincentives to make decisions that run counter to the patient’s wishes

      • But, although there is a duty to the institution, including possibly a contractual one
        • Physician carries the direct responsibility for patient care
        • May have more legal risk than the institution if the patient’s care is compromised
    • When physicians are uncertain as to the approaches to resolving a given case
      • Legal counsel may be sought

      • Important for the physician to recognize that hospital counsel represents the health care institution
        • May not focus on the needs of the individual physician
        • In addition, legal counsel’s primary duty is to protect the client from legal liability, not necessarily to facilitate ethical practice
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