Legal and
Ethical Dilemmas

Learning Objectives

Upon completing the course you'll be able to:

Chapter 1: Advance Directives and End-of-Life Decisions

  1. Explain two kinds of advanced directives: Living Wills, Durable Power of Attorney for Health Care.

  2. Explain patient self determination act and describe the responsibilities of a health care provider under it.

  3. Explain why anyone would need an advanced directive.

  4. Describe two benefits of appointing a health care agent.

  5. Describe two things one should do to ensure that his or her advanced directives will be honored.

  6. Distinguish between a will, a living trust, and a living will.

  7. Distinguish between a power of attorney and a durable power of attorney and a durable power of attorney for health care.

Chapter 2: Durable Power of Attorney or Living Will?

  1. Durable power of attorney or living Will?

  2. Explain the uses and respective advantages and disadvantages of a Durable Power of Attorney and a Living Will.

  3. List 6 duties of the Attorney-in-Fact.

  4. Explain "spring" Durable Power of Attorney.

Chapter 3: Common Misconceptions

12. Discuss with a patient at least 6 common misconceptions concerning advanced directives.

Chapter 4: Medical Treatments and your Advanced Directives

13. Explain the following medical treatments:

  • Life support
  • Cardiopulmonary resuscitation (CPR)
  • Mechanical ventilation
  • Artificial nutrition and hydration
  • Kidney Dialysis
  • Other medical treatments, such as surgical procedures, diagnostic studies, antibiotics, blood transfusion, chemotherapy and radiation therapy.

14. Formulate a values questionnaire to assist individuals upon end of life treatment decisions.

Chapter 5: Artificial Nutrition and Hydration

15. Define artificial nutrition and hydration.

16. Distinguish artificial nutrition and hydration from ordinary eating and drinking.

17. Explain the consequences of the withdrawal of artificial nutrition and hydration.

  1. List 7 considerations which will help an individual in making decisions about the use of artificial nutrition and hydration.

Chapter 6: CPR, DNR and End-of-Life Decisions

19. Explain what a DNR is, and discuss its application with a patient.

20. Distinguish between a hospital and non-hospital DNR orders.

21. Discuss 7 guidelines for the appropriate use of DNR orders.

Chapter 7: Dying at Home

22. List 3 advantages of dying at home.

23. Define hospice.

24. Discuss legal considerations concerning dying at home decisions.

Chapter 8: Ethics Committees and End-of-Life decisions

25. Discuss the role of ethics committees and patients right to make end-of-life decisions.

Chapter 9: Third Parties - Can They Take Away Your Rights?

26. Discuss the legal standing of third parties intervening with a persons end of life decision.

Chapter 10: Enforcing the Right to Refuse Treatment

  1. Discuss the two case studies laid out in this chapter and a patients family or friends outline various steps a patients family or friends should take to enforce his or her right to refuse treatment.

Chapter 11: Oregons assisted Suicide Law

28. Discuss various provisions and implications of Oregons Assisted Suicide Law.

Chapter 12: Organ Donation

29. Discuss the need for Organ Donation and provisions of the Uniform Anatomical Gift Act (UAGA).

Evaluation of Individual Objectives

To assess the effectiveness of the course material, we ask that you evaluate your achievement of each learning objective on a scale of A to D (A=excellent, B=good, C=fair, D=unsatisfactory). Please indicate your responses next to each learning objective and return it to us with your completed exam.
Course Outline

Chapter 1: Advance Directives and End-of-Life Decisions
  • Advance directives
  • Patient self-determination act
  • Durable power of attorney for health care
  • Living will and also appoint an agent
  • Benefits of appointing a health care agent
  • Benefits of having a living will
  • Preparing the Forms
  • The Witness
  • Complete advance directives
  • Medical Treatment and Your Advances Directives
  • Life-sustaining treatments
  • Life-support
  • Learn the Benefits and Burdens of different medical treatments
  • CPR
  • Refusing a life support
  • Difference between an artificial nutrition (tube feeding) and hydration
  • Other Questions
  • When to stop medical treatment.
  • When a health care provider won't honor an advance directive
  • Federal law on advance directives
  • The difference between a "Will" and "Living Trust"
  • The difference between a "Power of Attorney" and "Durable Power of Attorney"

Chapter 2: Durable Power of Attorney or Living Will

  • Duties of the attorney-in-fact
  • Successor attorneys-in-fact
  • Compensation of the agent
  • Precautions
  • Statuary language
  • Advantages of a "springing" power
  • Determination of disability

Chapter 3: Common Misconceptions

  • Signing an Advance Directive
  • The Effect of State Law
  • Restrictions on tube feeding and hydration
  • The rules for appointing a health-care agent
  • Medical Conditions and Treatments Not Specifically Covered by the Statue
  • Restrictions on Tube Feeding and Hydrations
  • Appointing a health care agent

Chapter 4: Medical Treatments and Your Advances Directives

  • Life Support
  • Cardiopulmonary resuscitation (CPR)
  • Kidney Dialysis
  • Discuss medical treatment with a doctor
  • Pain management
  • Stopping a medical treatment
  • Values Questionnaire
  • Overall attitude toward life
  • Thoughts about independence and control
  • Overall attitude toward health
  • Attitude toward illness, dying and death
  • Perception of your doctor & other caregivers
  • Personal relationship
  • Religious background and relief

Chapter 5: Artificial Nutrition And Hydration

  • Artificial nutrition and hydration
  • Side effects from artificial nutrition and hydration
  • Artificial nutrition and hydration different from ordinary eating and drinking
  • Withdrawal of artificial nutrition and hydration
  • Appropriate to give artificial nutrition and hydration
  • Advantages on refusing nutrition
  • Laws abut artificial and hydration
  • Stopping an artificial nutrition and hydration
  • A doctor insisting on providing artificial nutrition and hydration
  • Refusing artificial nutrition and hydration
  • Life insurance policies affecting life sustaining treatments
  • Medical community on ethically permissible to stop artificial nutrition and hydration
  • Nursing homes and hospital agree on stopping artificial and hydration
  • Use of artificial and hydration

Chapter 6: CPR, DNR and End-of-Life Decisions Cardiopulmonary Resuscitation

  • Someone refusing a CPR
  • Do-not-resuscitate order
  • DNR order
  • Instructions in a living will enable a person to avoid CPR
  • DNR orders governed by the law
  • Consenting to a DNR order
  • Discussing a DNR order with a physician
  • Questions to ask about DNR to a physician
  • Revoking a DNR order
  • Non-hospital Do-Not-Resuscitate order
  • A hospital DNR order
  • A non-hospital DNR orders
  • Living will or medical power of attorney be honored by EMS personnel
  • Non-hospital DNR orders governed by state law
  • Revoking a non-hospital DNR orders
  • Discussion of Legal and Ethical Issues
  • Guidelines for the Appropriate Use of Do-Not-Resuscitate Orders

Chapter 7: Dying At Home

  • A person right to die at home
  • Advantage to die at home
  • Disadvantages to die at home
  • Medical Considerations
  • A doctor's role when a patient is dying at home
  • Hospice
  • Difference between a home health care and hospice
  • Legal Considerations
  • Cost of hospice or home health care
  • Hospital responsibilities toward a person who has decided to die at home
  • Families member legal risk allowing a loved ones to die in their homes
  • Person dying at home changed his or her mind
  • When the Dying Person Is In the Hospital
  • How to prepare a dying person's discharge
  • Care-plan
  • When the Dying Person Is At Home
  • How to prepare for their love one's death
  • Advance Directives
  • Non-hospital DNR order
  • Preventing unwanted hospitalization
  • Stopping medical treatment at home without the doctor's knowledge
  • Family risk for proving too much pain medication
  • Supporting a loved one throughout the dying process
  • Support for the family
  • How to know when a loved one is near to death
  • After Death
  • How to make sure that their loved one is dead
  • Who to call after the death
  • Calling 911 after the person's death
  • Signing the death certificate
  • Autopsy

Chapter 8: Ethics Committees and End-Of-Life Decisions

  • The Ethics Committee of Harbor Hospital Center Cautions

Chapter 9: Third Parties Can They Take Away Your Rights

  • Third-Party Intervention and the Law
  • Chapter 10: Enforcing The Right To Refuse Treatment
  • To Honor a Living Will
  • Getting A Court Order

Chapter 11: Oregon's Assisted Suicide Law

  • The Oregon Death Dignity Act Allow
  • Concerns
  • Expectations

Chapter 12: Organ Donation

  • Considering an organ donor
  • Laws that govern organ donation
  • Advance directives to donate organs
  • Conflict existing between an advance directives and donating an organ

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