GROUP 3 GROUP 3 1. Information on the Terri Schaivo Case 1. Information on the Terri Schaivo Case (Glenn) (Glenn) 2. Living Wills (Kelly) 2. Living Wills (Kelly) 3. DNR Orders (Dave) 3. DNR Orders (Dave) 4. Power of Attorney for Healthcare 4. Power of Attorney for Healthcare (Heather) (Heather) 5. Declarations to Physicians (Jenalee) 5. Declarations to Physicians (Jenalee) 6. Wisconsin Statutes (Mary) 6. Wisconsin Statutes (Mary) 7. Case Law (Nate) 7. Case Law (Nate)
Transcript
GROUP 3GROUP 3
1. Information on the Terri Schaivo Case 1. Information on the Terri Schaivo Case (Glenn)(Glenn)
2. Living Wills (Kelly)2. Living Wills (Kelly) 3. DNR Orders (Dave)3. DNR Orders (Dave) 4. Power of Attorney for Healthcare 4. Power of Attorney for Healthcare
(Heather)(Heather) 5. Declarations to Physicians (Jenalee)5. Declarations to Physicians (Jenalee) 6. Wisconsin Statutes (Mary)6. Wisconsin Statutes (Mary) 7. Case Law (Nate)7. Case Law (Nate)
Terri Schiavo BackgroundTerri Schiavo Background
Born Theresa Marie Schindler on Born Theresa Marie Schindler on December 03, 1963 in Pennsylvania.December 03, 1963 in Pennsylvania.
Her family consists of her two parents Her family consists of her two parents and a brother and sister.and a brother and sister.
She met Michael Schiavo at Bucks She met Michael Schiavo at Bucks County Community College.County Community College.
Terri Schiavo BackgroundTerri Schiavo Background
Terri & Michael were married, at age Terri & Michael were married, at age 20 & 21, in November of 1984.20 & 21, in November of 1984.
Moved to St. Petersburg, FL with Moved to St. Petersburg, FL with Terri’s parents in 1986.Terri’s parents in 1986.
Terri & Michael never had children Terri & Michael never had children together.together.
What Happened?What Happened?
Feb 25, 1990: Terri suffers cardiac Feb 25, 1990: Terri suffers cardiac arrest.arrest.
Brain is damaged due to lack of Brain is damaged due to lack of oxygen.oxygen.
June 30, 1990 Court appoints Michael June 30, 1990 Court appoints Michael as guardian.as guardian.
Allegations that Michael caused Terri’s Allegations that Michael caused Terri’s injury have never been proven true.injury have never been proven true.
Love or Money?Love or Money?
August 1992: Terri awarded $250,000 August 1992: Terri awarded $250,000 in malpractice settlement.in malpractice settlement.
November 1992: Michael Schiavo gets November 1992: Michael Schiavo gets $300,000 and $750,000 put in trust for $300,000 and $750,000 put in trust for Terri from malpractice trial.Terri from malpractice trial.
May 1998: Michael petitions the court May 1998: Michael petitions the court to have feeding tube removed.to have feeding tube removed.
The Battle BeginsThe Battle Begins
Terri’s parents fight to have Michael Terri’s parents fight to have Michael removed as guardian.removed as guardian.
Terri’s feeding tube removed and Terri’s feeding tube removed and reinserted 3 times.reinserted 3 times.
Politicians get involved.Politicians get involved. Terri’s Law found unconstitutional by Terri’s Law found unconstitutional by
the US Supreme Courtthe US Supreme Court
ConclusionConclusion
March 18, 2005: March 18, 2005: Feeding tube is Feeding tube is removed.removed.
March 31, 2005: Terri March 31, 2005: Terri Schiavo dies at 9:05 Schiavo dies at 9:05 a.m. at age 41.a.m. at age 41.
An autopsy was An autopsy was performed.performed.
April 4, 2005: Terri’s April 4, 2005: Terri’s body was cremated.body was cremated.
Living WillsLiving Wills A living will states in advance a A living will states in advance a
person's desire to receive, or to person's desire to receive, or to withhold, life-support procedureswithhold, life-support procedures
It is put into use if someone becomes It is put into use if someone becomes permanently unconscious or terminally permanently unconscious or terminally ill and unable to make decisionsill and unable to make decisions
Requirements to CreateRequirements to Create
18 years or older18 years or older Must have sound mindMust have sound mind Must be witnessed by two adultsMust be witnessed by two adults
Application of Living WillsApplication of Living Wills
Living wills become applicable when Living wills become applicable when two doctors determine that the patient two doctors determine that the patient is in an irreversible coma or unable to is in an irreversible coma or unable to make decisions for themselvesmake decisions for themselves
Cannot Cannot be used if the person is able to be used if the person is able to make health care decisionsmake health care decisions
Treatments Covered by Treatments Covered by Living WillsLiving Wills
Permits the withholding or Permits the withholding or withdrawing of life-prolonging withdrawing of life-prolonging treatment that artificially extends the treatment that artificially extends the dying process.dying process.
Some states allow the removal of Some states allow the removal of artificial nutrition when the patient is artificial nutrition when the patient is in an irreversible comain an irreversible coma
Revoking a Living WillRevoking a Living Will
Can be revoked at any time by:Can be revoked at any time by:– Destroying the documentDestroying the document– Expressing orally to witnesses the desire Expressing orally to witnesses the desire
to revoketo revoke– Written documentation the desire to Written documentation the desire to
revokerevoke
DNR OrderDNR OrderWhat is it?What is it?-A do not resuscitated order tells doctors, A do not resuscitated order tells doctors, nurses, medical professionals and EMT’s not nurses, medical professionals and EMT’s not to perform CPR on them if they stop to perform CPR on them if they stop breathing or their heart stopsbreathing or their heart stops
Why are they issued?Why are they issued?--DNR codes are normally issued when someone is critically DNR codes are normally issued when someone is critically
or terminally ill because if CPR is performed on them or terminally ill because if CPR is performed on them they might still be in a worse state than they were in they might still be in a worse state than they were in before CPR was performed.before CPR was performed.ex: brain damageex: brain damage
How are they issued?How are they issued?-Any adult can write a DNR order for themselves.-Any adult can write a DNR order for themselves.-DNR can be orally to a doctor or written in a living will -DNR can be orally to a doctor or written in a living will
with two witnesses present.with two witnesses present.-Doctor must acknowledge you DNR order and if they do -Doctor must acknowledge you DNR order and if they do
not agree with a DNR order they must pass you on to not agree with a DNR order they must pass you on to another doctor or try to persuade you the other way another doctor or try to persuade you the other way before the DNR order comes about.before the DNR order comes about.
-If you cannot decide for yourself, if two doctors agree that -If you cannot decide for yourself, if two doctors agree that CPR would not work they will not perform CPR.CPR would not work they will not perform CPR.
-A Child DNR order can be issued with the consent of the -A Child DNR order can be issued with the consent of the guardians and if the child is old enough to understand guardians and if the child is old enough to understand they also have to consent to this decision.they also have to consent to this decision.
When you are personally not able to consent to a When you are personally not able to consent to a DNR order who can in your place?DNR order who can in your place?
A close family member or close friend when:A close family member or close friend when:1.you are terminally ill1.you are terminally ill2.you are permanently unconscious2.you are permanently unconscious3.CPR will not work3.CPR will not work4.CPR will impose burden on medical conditions4.CPR will impose burden on medical conditions
-but this decision MUST be made on your thoughts of your -but this decision MUST be made on your thoughts of your best interestbest interest
Miscellaneous Miscellaneous --Any adult can write a DNR orderAny adult can write a DNR order-You can also remove a DNR order at any time-You can also remove a DNR order at any time-If you are transferred from a hospital to a nursing home -If you are transferred from a hospital to a nursing home
or nursing home to home care, etc you have to transfer or nursing home to home care, etc you have to transfer your DNR and make sure that your doctor is informed of your DNR and make sure that your doctor is informed of this fact.this fact.
-If CPR is going to be futile for you doctor can forgo CPR -If CPR is going to be futile for you doctor can forgo CPR but must inform your family and they must agreebut must inform your family and they must agree
-If family disagrees with the DNR order they will make -If family disagrees with the DNR order they will make every way to communicate to patient and family to drop every way to communicate to patient and family to drop it, but in difficult cases they will normally perform CPR it, but in difficult cases they will normally perform CPR anyways to try to save the patient.anyways to try to save the patient.
--Emt will perform CPR even if you have a DNR orderEmt will perform CPR even if you have a DNR order
Power of Attorney for Power of Attorney for HealthcareHealthcare
You may voluntarily elect a person to You may voluntarily elect a person to make medical care, custody and make medical care, custody and treatment decisions for you if you treatment decisions for you if you become unable to express your become unable to express your medical caremedical care
Your Agent is granted Your Agent is granted authority over a number of authority over a number of things.things. Consent to, or refuse to consent to, various medical Consent to, or refuse to consent to, various medical
treatmentstreatments Access your medical recordsAccess your medical records Make arrangements such as at a hospital or nursing Make arrangements such as at a hospital or nursing
homehome Hire and fire your health care providersHire and fire your health care providers Move you to a different stateMove you to a different state Visit youVisit you Execute legal documents on health care matters for Execute legal documents on health care matters for
youyou
The things your agent The things your agent cannot do by law.cannot do by law.
Revoking your living willRevoking your living will
May also prohibit authorizing the withdrawal May also prohibit authorizing the withdrawal of life supportof life support
Who may sign a Power of Who may sign a Power of Attorney for Healthcare?Attorney for Healthcare?
Sound MindSound Mind
Age 18 or olderAge 18 or older
Who may not be a witness.Who may not be a witness.
Not related to you by blood, marriage, Not related to you by blood, marriage, adoption and not be directly financially adoption and not be directly financially responsible for your healthcareresponsible for your healthcare
Not a healthcare provider who is serving Not a healthcare provider who is serving you at the time the document is singedyou at the time the document is singed
Anyone who has a claim on any portion of Anyone who has a claim on any portion of your estateyour estate
What happens if the person What happens if the person I appoint dies or is not able I appoint dies or is not able to serve as my agent?to serve as my agent?
Successor agentsSuccessor agents
What happens if I name my What happens if I name my spouse as my agent and we spouse as my agent and we are later divorced?are later divorced?
The ex-spouse will no longer have the The ex-spouse will no longer have the authority to act under the healthcare power authority to act under the healthcare power of attorneyof attorney
Will my agent be held liable Will my agent be held liable for my healthcare costs?for my healthcare costs?
NoNo
When does it take effect?When does it take effect?
Finding incapacity by 2 physicians, or one Finding incapacity by 2 physicians, or one physician and one licensed psychologistphysician and one licensed psychologist
Let people know your feelingsLet people know your feelings Consider the future kinds of treatment Consider the future kinds of treatment
decisionsdecisions Name a person you trustName a person you trust Fill out a formFill out a form Make sure you are specific in your wordingMake sure you are specific in your wording Make it in writingMake it in writing Disperse the formDisperse the form Make the statement part of your medical Make the statement part of your medical
recordrecord
WI StatutesWI Statutes
Declaration to Physicians/ Living WillsDeclaration to Physicians/ Living Wills ~ ~ W.S.A. 154W.S.A. 154DNR DNR ~ ~ W.S.A. 154W.S.A. 154Power of Attorney for Healthcare Power of Attorney for Healthcare ~ ~ W.S.A. 155W.S.A. 155
Declaration to Declaration to Physicians/ Living WillsPhysicians/ Living Wills W.S.A. 154.03W.S.A. 154.03
– Must be of sound mindMust be of sound mind– 18yrs or older18yrs or older– 2 Witnesses2 Witnesses
Who is not eligible?Who is not eligible?– Individuals related by blood, marriage or adoptionIndividuals related by blood, marriage or adoption– Knowledge of declarant’s estateKnowledge of declarant’s estate– Individual in charge of declarants financial Individual in charge of declarants financial
healthcarehealthcare– Someone who is a healthcare provider: social Someone who is a healthcare provider: social
workerworker
Revocation of declaration Revocation of declaration
W.S.A. 154.05W.S.A. 154.05– MethodMethod
PhysicalPhysical Written Written OralOral By executing a subsequent declarationBy executing a subsequent declaration
– Revocation shall be recorded by the Revocation shall be recorded by the physicianphysician
Do Not Resuscitate (DNR) Do Not Resuscitate (DNR)
W.S.A. 154.17 (2)W.S.A. 154.17 (2)““a written order issued under the a written order issued under the requirements of this subchapter that requirements of this subchapter that directs emergency medical technicians, directs emergency medical technicians, first responders and emergency health first responders and emergency health care facilities personnel not to attempt care facilities personnel not to attempt cardiopulmonary resuscitation on a cardiopulmonary resuscitation on a person for whom the order is issued if person for whom the order is issued if that person suffers cardiac/ respiratory that person suffers cardiac/ respiratory arrest”arrest”
Revocation of DNRRevocation of DNR
W.S.A. 154.21W.S.A. 154.21– Verbally to first respondentVerbally to first respondent– Physical removal of bracelet: Physical removal of bracelet:
defaces, burns or cut offdefaces, burns or cut off
Power of Attorney for Power of Attorney for HealthcareHealthcare W.S.A. 155.05W.S.A. 155.05
– Must be of sound mindMust be of sound mind– 18yrs or older18yrs or older– 2 Witnesses2 Witnesses
To Revoke Power of To Revoke Power of Attorney for HealthcareAttorney for Healthcare
W.S.A. 155.40W.S.A. 155.40a) Physical destruction a) Physical destruction b) Verbal (presence of 2 witnesses)b) Verbal (presence of 2 witnesses)c) Written c) Written d) Marriage/ divorced) Marriage/ divorcee) Executing a subsequent power of e) Executing a subsequent power of
attorney for health care instrumentattorney for health care instrument
Declarations to PhysiciansDeclarations to Physicians(Living Wills)(Living Wills)
Definition: A Declaration to Definition: A Declaration to Physicians forms makes it possible Physicians forms makes it possible for adults to state their preferences for adults to state their preferences for life-sustaining procedures and for life-sustaining procedures and feeding tubes in the event the feeding tubes in the event the person is in a terminal condition or person is in a terminal condition or persistent vegetative state. persistent vegetative state.
Definition (cont’d)Definition (cont’d)
The withholding or withdrawal of any The withholding or withdrawal of any medication, life-sustaining procedure, medication, life-sustaining procedure, or feeding tube may not be made if or feeding tube may not be made if the attending physician:the attending physician:
2.2. Advises that doing so will cause pain Advises that doing so will cause pain or reduce comfort.or reduce comfort.
3.3. The pain or discomfort cannot be The pain or discomfort cannot be alleviated through pain relief alleviated through pain relief measures.measures.
Terminal IllnessTerminal Illness
Definition: an incurable condition caused Definition: an incurable condition caused by injury or illness that reasonable medical by injury or illness that reasonable medical judgment finds would cause death judgment finds would cause death imminently, so that the application of life-imminently, so that the application of life-sustaining procedures serves only to sustaining procedures serves only to postpone the moment of death.postpone the moment of death.
Persistent Vegetative Persistent Vegetative StateState Definition: a condition that reasonable Definition: a condition that reasonable
medical judgment finds constitutes medical judgment finds constitutes complete and irreversible loss of all complete and irreversible loss of all the functions of the cerebral cortex the functions of the cerebral cortex and results in a complete, chronic, and and results in a complete, chronic, and irreversible cessation of all cognitive irreversible cessation of all cognitive functioning and consciousness, and a functioning and consciousness, and a complete lack of behavioral responses complete lack of behavioral responses that indicate cognitive functioning, that indicate cognitive functioning, although autonomic functions although autonomic functions continue.continue.
RequirementsRequirements 2 witnesses are 2 witnesses are
required, must be at required, must be at least 18 years old, not least 18 years old, not related by blood, related by blood, marriage, or adoption, marriage, or adoption, and not directly and not directly financially responsible financially responsible for your health care.for your health care.
If unable to sign, the If unable to sign, the declaration must be declaration must be signed in the signed in the delcarant’s name by delcarant’s name by one of the witnesses or one of the witnesses or another person another person designated by the designated by the delcarant. delcarant.
Witnesses cannot be Witnesses cannot be persons who know persons who know they are entitled to they are entitled to or have a claim on or have a claim on any portion of your any portion of your estate.estate.
Witnesses cannot be Witnesses cannot be a health care a health care provider, unless a provider, unless a chaplain, social chaplain, social worker, or employee worker, or employee of an inpatient care of an inpatient care facility in which you facility in which you are a patient.are a patient.
Ways to Protect your Ways to Protect your Declaration to Declaration to PhysicianPhysician
Make friends and Make friends and relatives aware that relatives aware that you have signed the you have signed the document and where document and where it is kept.it is kept.
Keep a signed form in Keep a signed form in a safe, easily a safe, easily accessible place.accessible place.
Notify your attending Notify your attending physician that you physician that you have a declaration.have a declaration.
Make sure the Make sure the attending physician attending physician keeps the document keeps the document with your medical with your medical recordsrecords
Ways to Revoke your Ways to Revoke your DeclarationDeclaration1.1. By a written revocation of the declarant By a written revocation of the declarant
expressing the intent to revoke, signed expressing the intent to revoke, signed and dated by the declarant.and dated by the declarant.
2.2. By executing a subsequent declaration.By executing a subsequent declaration.3.3. By a verbal expression by the declarant of By a verbal expression by the declarant of
his/her intent to revoke the document.his/her intent to revoke the document.4.4. By being cancelled, defaced, obliterated, By being cancelled, defaced, obliterated,
burned, torn, other otherwise destroyed burned, torn, other otherwise destroyed by the declarant or some person who is by the declarant or some person who is directed by the declarant. directed by the declarant.
Case LawCase LawSpahn v. EisenbergSpahn v. Eisenberg563 N.W.2d 485 (Wis. 1997)563 N.W.2d 485 (Wis. 1997)
Facts of CaseFacts of Case
Spahn sought remedy from courts Spahn sought remedy from courts because wanted her sister to no longer because wanted her sister to no longer have nutrients given to herhave nutrients given to her
Edna was not categorized as being in Edna was not categorized as being in a permanent vegatative state. She a permanent vegatative state. She suffered from dementia but was not suffered from dementia but was not expected to improveexpected to improve
Facts of Case Contin.Facts of Case Contin.
No advanced directivesNo advanced directives Support system would have been Support system would have been
discountinued if all family agreed. discountinued if all family agreed. Niece declinedNiece declined
Guardian ad litem was appointed Guardian ad litem was appointed during proceedingduring proceeding
Lower court dismissed caseLower court dismissed case
Questions for CourtQuestions for Court
Can the guardian of a non-vegetative Can the guardian of a non-vegetative but incompetent person discontinue but incompetent person discontinue support systems?support systems?
Answer: NOAnswer: NO
Questions for CourtQuestions for Court
Was there sufficient evidence present Was there sufficient evidence present to conclude that Edna would rather die to conclude that Edna would rather die than live with supports?than live with supports?
Answer: NOAnswer: NO
Reasoning for 1Reasoning for 1stst Answer Answer
Precedent requires that “clear and Precedent requires that “clear and convincing” evidence be presented in order convincing” evidence be presented in order to end the life of a person who is to end the life of a person who is incompetentincompetent
Precedent states that a competent or Precedent states that a competent or incompetent person has the right to refuse incompetent person has the right to refuse medical treatment through advanced medical treatment through advanced directives and other recognized means of directives and other recognized means of refusal and that a legal guardian may carry refusal and that a legal guardian may carry out those wishesout those wishes
Reasoning for 1Reasoning for 1stst Answer Answer
There are four main considerations to which the There are four main considerations to which the state must adhere in respects to decisions about state must adhere in respects to decisions about incompetent persons:incompetent persons:
2.2. The preservation of life is the most important The preservation of life is the most important factor in the states decision.factor in the states decision.
3.3. The state must strive to safeguard the integrity of The state must strive to safeguard the integrity of the medical profession.the medical profession.
4.4. The state cannot participate in an act that results The state cannot participate in an act that results in euthanasia.in euthanasia.
5.5. The state must attempt to protect innocent third The state must attempt to protect innocent third parties.parties.
Reasoning for 2nd Reasoning for 2nd AnswerAnswer The only supporting evidence that The only supporting evidence that
Edna would not want to live in her Edna would not want to live in her current state was made 30 years prior current state was made 30 years prior to this case, during a family crisis.to this case, during a family crisis.
The comments that were made did not The comments that were made did not provide any solid evidence of Edna’s provide any solid evidence of Edna’s wishes.wishes.
IMPORTANCE!!!IMPORTANCE!!!
The court has created a “bright line” The court has created a “bright line” rule stating that incompetent persons rule stating that incompetent persons may not have life-support systems may not have life-support systems withdrawn unless the following withdrawn unless the following conditions are present:conditions are present:
Conditions:Conditions:
1.1. The incompetent person is in a The incompetent person is in a permanent vegetative state and permanent vegetative state and doing so is in the person’s best doing so is in the person’s best interest.interest.
2.2. The incompetent person has left The incompetent person has left advanced directives oradvanced directives or
3.3. There is clear and convincing There is clear and convincing evidence of the incompetents wishes.evidence of the incompetents wishes.
