End Of Life Care

In the article, Legal Aspects of End of Life Care, author, Nurse Claire M. McGowan, explains that when performing the role of a critical care nurse acting as the advocate for the patient, his/her family, and significant others, it is essential that the nurse has an understanding of legal implications associated with end of life care. McGowan goes on to provide information on the legal principles involved in end-of-life care, specifically addressing: limitations in treatment, assessing capacity and using surrogate decision makers and medical futility.
In order to explain limitations in treatment, McGowan begins by listing what the courts have established as life-sustaining treatments which include: mechanical ventilation, blood transfusions, dialysis, chemotherapy, artificial nutrition, and hydration. Although a competent or incompetent terminally ill patient with advances directives has the right has to refuse these treatments, there are rare cases when the state court may override that right: preservation of life, prevention of
According to McGowan, arriving at this determination and accepting futility is often stressful, inciting disagreements between the patients/surrogates and medical professionals involved. In order to resolve conflicting interests, McGowan suggests a variety of methods that can be utilized to improve communication between the two parties including: making attempts to negotiate understanding between parties as to what constitutes futile care before conflict arises, using joint decision making, and using consultants to reach satisfactory resolution of disagreements. If these methods fail to help unite the parties’ decision an ethics committee may be utilized to reach a determination, the patient may be transferred to another medical provider within the institution or to another institution altogether (McGowan,