Chapter 6 – The Last Dance

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Prepare for it
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When we acknowledge the inevitability of death, we can prepare for it. Planning helps ensure that we do not add to the burdens carried by our survivors.
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3 Legal Principals of Legal Consent
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Informed consent is based on three legal principles: First, the patient must be competent to give consent. Second, consent must be given freely. Third, consent must be based on an adequate understanding of the proposed treatment, including any potential risks.
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Beneficence
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A fundamental principle in medical care which involves doing good or conferring benefits that enhance personal or social well-being. This principal is sometimes expressed by it counterpart, non-maleficence, or the injunction to \”do no harm.\”
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1961
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A study in 1961 found that most doctors had a strong and general tendency to withhold information. None of the doctors surveyed at that time reported a policy of telling every patient about a life-threatening diagnosis.
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SUPPORT Study
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A study designed to assess communication between physicians and seriously ill patients at the end of life found disturbing shortcomings. The study, known by it’s acronym, SUPPORT, was a multicenter \”Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment.\” The SUPPORT study revealed that people were suffering terrible deaths in hospitals, in pain, and with no power to control the last stage of their lives.
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Karen Ann Quinlan (1975)
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Ethical questions regarding a \”right to die\” first came to widespread public attention in the court case involving Karen Ann Quinlan 1975.
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Karen Ann Quinlan ?
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21 yr old found not breathing in her bed after a night out at a bar. She was in a coma and put on life support. After several months her parents wanted life support removed so Karen could die naturally. They went to court …. first case for \”right to die\” came to public attention. Karen survived after life support was removed. She died 10 years after falling into a coma.
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Coma
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A state of profound unconsciousness and unresponsiveness. Usually, after a few days or weeks, patients either regain consciousness , progress to a vegetative state, or die (if the entire brain stem is permanently nonfunctional, then the diagnosis is brain death rather than coma).
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Dr. Jack Kevorkian
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Provided aid-in-dying to more than 100 people and led a personal crusade to legalize physician-assisted suicide.
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Oregon & Washington
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Currently, physician-assisted death is permitted by legislation enacted in the states of Oregon and Washington and by court ruling in the state of Montana. In May 2013, the Vermont senate passed and the governor signed the \”Patient Choice and Control at End of Life Act,\” adding Vermont to the list.
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Greek – Easy Death
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Euthanasia (from Greek, \”easy death\”) involves a deliberate act to end another person’s life. It is generally understood as the intentional act of killing someone who would otherwise suffer from an incurable and painful disease.
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Voluntary Euthanisa
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Euthanasia performed with the patient’s consent.
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Non-Voluntary Euthanasia
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This type of euthanasia occurs when a surrogate decision maker asks a physician for assistance to end a patient’s life.
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Involuntary Euthanasia
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Euthanasia performed on patients against their will.
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Netherlands, Belgium, Luxembourg, Switzerland
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Industrialized countries identified in the text as permitting euthanasia to patients who request death.
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California 1976
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State became the first to adopt a Natural Death Act giving legal recognition to the living will.
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Advanced Directive
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Is any statement made by a competent person about choices for medical treatments should he or she become unable to make such decisions or communicate them at some time in the future.
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Living Will (type of advance directive)
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A living will allows an individual to refuse life-sustaining treatment in the event he or she is terminally ill and the administration of life-sustaining procedures would only prolong the dying process.
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Patient Self-Determination Act
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Requires providers of services under the Medicare and the Medicaid programs to inform patients of their rights to appoint a health care proxy and draw up written instructions concerning limits to medical care to be activated if they become incapacitated. Specifically, patients have rights to: 1. participate in and direct their own health care decisions, 2. accept or refuse medical or surgical treatment and 3. prepare an advance directive. \”MEDICAL MIRANDA WARNING\”
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Barton Bernstein – 3 Legal Stages That Apply in Cases of Terminal Illness
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FIRST STAGE – involves long-range planning, in which the terminally ill person arranges his or her legal and financial affairs for the eventuality of death. SECOND STATE – which occurs shortly before death, the survivors gather pertinent legal papers, obtain sufficient funds to cover immediate expenses and notify the attorney and insurance representative so they will be ready to make a smooth transition of the deceased’s legal and financial affairs. Organ donations preparations are also started at this time. THIRD STAGE – follows the death, the will is delivered to an attorney for probate.
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Nuncupative Will
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A will made orally. Many states do not recognize a nuncupative will or do so only under extremely limited circumstances. A few states admit an oral will if the person makes it in fear of imminent death or in the expectation of receiving mortal injuries, and the peril does result in death.
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Codicil
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Amending a will.
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How can a will be amended?
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A will can be amended by adding new provisions without having to rewrite it entirely…. ex: art collection or real estate … the attorney adds a new provision for the art collection or real estate without disturbing other parts of the estate plan or will.
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Interstate
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Condition of having no legal will.
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If a person dies without leaving a valid will
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property is distributed according to rules set up by the state.
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The State
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According to the laws of Interstate succession when no surviving heirs can be found proceeds from the estate go to the STATE.
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1759 – Presbyterian Synod of Philadelphia
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In the USA, the first insurance company was established in 1759 for its ministers.
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Benefits of Life Insurance
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Convenient way of leaving a basic estate for our beneficiaries when we die. They can be part of an investment portfolio that can be drawn upon during the insured’s lifetime. Some policies provide benefits payments only after the death of the insured.
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Viatical Settlement
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A viatical settlement allows a person with terminal illness to sell his or her life insurance policy before death and receive payment for a percentage of its face value. They usually pay about 70 percent of the face value of the policy.

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