1. Accessible Quality Care

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

3. 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

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

5. 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

6. 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

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

8. 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

9. 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

10. 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