Accessible Quality Care

Three Common Situations Hospice Care Food and Hydration Palliative vs. Terminal Sedation 2

Hospice Cecily Saunders and David Tasma Nature of pain Dying period: creative, productive, joyful “You matter because you are you. You matter to the last moment of your life, and we will do all we can not only to help you die peacefully, but help you live until you die.” 3

Hospice Under Medicare Terminal within 6 months Usually forego curative care Optional Can move in an out of service Can choose your own 4

Food and Hydration Basic care, not medical, not extraordinary, even if artificial Absolutely required unless death imminent or too burdensome(rare) Three confusing scenarios PVS or persistent vegetative state Imminent death Willful starvation and dehydration with sedation to hide 5

Palliative vs. Terminal Sedation Reversible, titrated, and monitored Focus is on symptom relief; no intention of dying or killing Death might rarely occur but should not and would be inadvertent Terminal Steadily increasing doses Edging the patient, not toward relief of symptoms, but toward increasing unconsciousness Death as the ultimate goal. 6

Protecting Yourself and Family Living Will Advance Healthcare Directives Durable Power of Attorney for Healthcare POLST 7

Advance Healthcare Directives All over 18 years of age should have one In force only when incapacitated or unwilling No attorney or notary required with few exceptions Generally honored by courts and hospitals Can be very complete and comprehensive Avoid specific details until the time of need Assign a surrogate for split-second decisions 8

Durable Power of Attorney for Healthcare Only kicks in when incapacitated Legally binding in terms of assignment but leaves decisions to a trusted person You pick the person who knows and understands your wishes Do not agree to act on behalf of someone if you do not agree with their wishes 9

POLST Increasingly popular with some groups Can’t be legally required Has full force of a doctor’s order Immediately actionable no matter your state of capacity Can be signed by someone who does not know you Checklist format with bias Opposed by USCCB and the Catholic Medical Association 10