1. Tulsa Estate Planning Forum October 11, 2011 Jennifer K. Clark, MD, FAAP Division Director, Palliative Medicine Departments of Internal Medicine and Pediatrics OU School of Community Medicine Advance Care Planning: A Doctor’s Perspective

2. What are we going to talk about?  Palliative Care…what is that?  A little history lesson…  Medicine  Ethics  Advance Directives:  Have you had the conversation?  Surrogate decision makers…”but I have power of attorney!”  Do Not Resuscitate Orders

3. Palliative Care What is Palliative Care?

4. Interdisciplinary care for persons with life-threatening illness or injury which addresses physical, emotional, social, and spiritual needs and seeks to improve quality of life for the ill person and his or her family. -Ira Byock, Director of Palliative Medicine at Dartmouth-Hitchcock Medical Center

5. Relief from Suffering Improve Quality of Life What is Palliative Care ? Share Honest Information with Patients and Families

6. What is Palliative Care ? Palliative Care HOSPICE Palliative Care is not equal to End-of-Life Care, Hospice, “Death & Dying” Palliative Care is not dependent on prognosis Palliative Care is not just for the elderly, it is for patients of all ages

7. What is Palliative Care ? Palliative Care HOSPICE L. Hospitium, hospitality, literally “house and guest” Home based palliative care Targets those with <6 months life expectancy

8. What is Palliative Care ? Curative Care Palliative Care Loss/Grief/Bereavement Disease Process Dying Process

9. A bit of history Social reform, ethics, and medicine… the perfect storm

10. A bit of history 2 major phenomena occurred simultaneously…  The loss of prognostics  Shift from Paternalism to Autonomy

11. Advance directives Advance Directives: A Doctor’s Perspective

12. OK Advance Directives  A Living Will…wishes for healthcare should you become incapacitated  Health Care Proxy…your appointed surrogate decision maker _______________________________________  (Anatomical Gifts)  (General Provisions)

13. OK Advance Directives  No Surrogacy law for medical decision making  OK law presumes you would want to be resuscitated and receive artificial nutrition and hydration

14. Do not resuscitate orders Advance Directives: A Doctor’s Perspective

15. OK DNR  For home or institution…for hospitalizations, an in- hospital DNR will be executed as well.  Consent form  Physician executed based on clear and convincing evidence

16. Insurance  Medicaid…no hospice benefit for those solely covered. However, long-term care is covered.  Commercial…most have hospice benefit, but extremely variable  Medicare…has hospice benefit. However, long- term care is NOT covered.

17. Thank you. Jennifer-K-Clark@ouhsc.edu For more information: OU Center for Palliative Care 918-619-4127 ***Website coming soon!*** Oklahoma Palliative Care Resource (OUHSC in OKC) http://www.fammed.ouhsc.edu/Palliative-Care/oklaw.htm Questions?