The Ethics in End-of-Life Decisions – Jackson Rainer

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This recording is designed to teach you strategies to facilitate discussions with dying individuals and families struggling with end-of-life care. Jackson Rainer, Ph.D., ABPP, author of Life After Loss: Contemporary Grief Counseling and Therapy, specializes in working with individuals, couples, and families struggling with the demands of chronic and terminal illness, end-of-life and palliative care, and issues related to grief and bereavement. Dr. Rainer will help you to be able to recognize the distinction between healing and cure and examine the nature of heroic treatment and futility. He will also cover complicated ethical challenges at the end of life and techniques for communicating empathy and compassion.

1. Discuss a philosophy of care when functional recovery is no longer possible.
2. Identify a model of decision making for judgments related to treatment options, regulated by the ethical principles of shared decision making and mutual respect.
3. Describe a communication structure for delivering “bad news” to patients and families.
4. Integrate a philosophy of limits to care with personal feelings of loss and failure.

The Ethical Principles Guiding End-of-Life Decision Making

• Beneficence, nonmaleficence, and autonomy at end-of-life
• Futility – when is it time to “call” the limits to treatment?
• Extraordinary Means and Heroic Measures – cure vs. care, salvage treatments
• Case Studies, the Law, and Court Rulings: Terrie Sciavo and Karen Ann Quinlan and their impact on decision making

Communication Strategies for Dealing with “Bad News”

• A systems approach to patients and their families
• Incorporation of “bad news” into treatment planning and palliative care
• Difficulties with advance directives – who makes the decisions in ambiguous situations?
• Identifying personal, cultural, and religious biases impacting treatment

Rationing and Inequities in Access to Healthcare

• The impact of the Affordable Care Act
• Distributive justice, heroic care, and futility

The Advanced Illness Coordinated Model

• Six steps

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