ORDINARY AND EXTRAORDINARY MEANS

OF TREATMENT:

1 . ORDINARY Treatment- kind of

treatment that is standard
2. EXTRAORDINARY Treatment
A kind of treatment that is
characterized by the following:

1. It is not readily available

2. It is risky, being
experimental/untested

3. its expected outcome is gravely

inconvenient or burdensome

FUTILITY OF TREATMENT
Does not simply mean the failure or
inability of treatment to attain any of
the general goals of medicine such as:
1. to cure
2. to palliate symptoms
3. to prevent disease or illness and its
complications
4/ to improve health condition to a
functional condition

To Prolong Life
Through the rise of
medical technology,
many of us avail of what
it offers because we
wish to prolong life and
to improve the quality of
life

Not to Prolong Life

This takes place when all other life
support is not improving the condition
of the patient, if the patient or the
family decides not to prolong the agony.

EXAMPLES:

1.DO NOT RESUSCITATE

ORDERS (DNR)
Depriving the patient of
Cardiopulmonary Resuscitation
(CPR)
Is judged to be clinically futile and
non-obligatory to be provided
should not be the decision of the
health care provider alone but
should be the result of consultation
either with the patient or with the
patients surrogate.

2. WITHDRAWAL OF LIFESUSTAINING TREATMENT

when all of life support is worth

nothing in the prognosis of the
patients condition.

It is determining when to
allow another to die is never a
comfortable situation. Despite
clinical experience health care
provider generally find
themselves uneasy deciding
when to discontinue an ongoing
treatment

ADVANCE CARE PLANNING

It is a planning process armed
at helping the competent
conscious and sane) patient
make medical care decisions in
anticipation of the thrive when
the ability to decide is lost or
impaired

What is Decision
Making Capacity?
It is a medical determination
relating only the issue at hand,
as people may have the ability
to make decisions about some
areas and not others.

The Elements of
Decision Making
Capacity:

The patient must;

have the ability to understand
all information
have the ability to communicate
understanding and choices
have personal values and goals
that guide the decision
have the ability to reason and
deliberate

GOALS OF ADVANCE HEALTH

CARE PLANNING
It answers that the patients goals
are served through appropriate
medical care
It ensures that the patient is
protected as treatment is adapted to
the patients needs seeing to it that
the patient is neither over-treated
nor under treated.

 It respects the patients right

to autonomy as it holds the
patient responsible for
medical decisions instead of
family members.
It helps minimize potential
misunderstanding and
conflicts between health care
providers and family members
in an end-of-life situation.

FOCUS OF ADVANCE HEALTH

CARE PLANNING :

1. Designation of a surrogate
decision maker
2. Type of adverse health
situations and how the patient
feels about these.
3. Kind of life-saving/sustaining
treatments and his options on
these,,
4/ Fears or concerns of the patient
on death and the manner of dying
5/ Writing the patients wishes to
avoid possible disagreements.

Advance Directives

This is the written part of Advance

Care Planning, it is in the directive
that the competent patient makes
known his preferences that will be
considered when for any reason
he is no longer be able to speak
for himself.

It alleviates stress on family

and clinicians when dealing with
end-of-life concerns.

I,______, am of sound mind, an I voluntarily make the declaration.

I direct that life-sustaining procedures should be withheld or
withdrawn if I have an disease illness or injury, or experienced
extreme mental deterioration, such that these no reasonable
expectation of restoring or regaining a meaningful life.
These life-sustaining procedure that may be withheld or
withdrawn include but are not limited to:
Cardiac resuscitation. Vintalatory support, Antibiotics, Artificial
feeding and Hydration.
I further direct that treatment be limited to palliative measures,
even if I shorten my life.
My family, the medical facility, any physician, nurses and other
medical personnel involved in my care shall have no civil or
criminal liability for following my wishes as expressed to this
declaration.
I signed this document after careful consideration
I understand its meaning and I accept its consequences.
Date:------Signed:-----------Addressed:-----------These declaration was signed n our presence. The declaration
appears to be of sound mind and to be making this declaration
voluntarily without duress, fraud or undue influence.
Signed of
witness:---Signed of
witness:----

TYPES OF DOCUMENTS IN
ADVANCE DIRECTIVES

A.LIVING WILLS (Instructive)

These are legal documents giving
directions to health care providers
related to withholding or
withdrawing life support if certain
conditions exist
This guides decisions by indicating a
persons desires regarding lifesustaining interventions
A problem encountered in Living
Wills is that it may not indicate the
current desires of the person.

 B. DURABLE POWER OF ATTORNEY (Proxy

directive)

Is a document that allows a

competent person to designate another
as a surrogate or proxy to act on her or
his behalf in making health care
decisions in the event of the loss of
decision making capacity.
The designating person may revoke the
Durable Power of Attorney anytime by
changing the person named or by
destroying the document.
This does not become effective until it
has been determined that the
designating person has lost decision
making capacity.

SURROGATE - is the person

designated to make the decisions in
behalf of the patient.
Qualifications of a surrogate:
has intimate knowledge of patients wishes or value systems
does not go outside ethical principles
should not be competent themselves but well informed
committed with the interest of the incompetent patient
free of conflicts of interest
should sign informed consent

Reasons why the patients family disagree

with the advance care directive

1. Difference in how best to attain

the patients interests.
2. Disagreement with the health
care providers interpretation of the
Living Will.
3. Claim of patients change of
views or attitude towards medical
care decisions

Advance Care Directives:

1. Do you have basic information
about advance care directives,
including wills and durable
power of attorney?
2. Do you wish to indicate an
advance directive care, if you
have already prepared one can
you provide it now?
3. Have you discussed your endof-life choices with your family
and/or designated surrogate and

Who are not qualified to make an

Advance Care Directive Plan?
1. Show risk for early dementia
2. Show high risk for stroke such as
those who show chronic
hypertension or abnormally high
blood pressures.
3. Those engaged in activities that
are highly associated with serious
head injuries, like for instance, car
racers, motor cyclists, etc.
4. Those who experience severe
and receiving psychiatric illnesses.
5. The terminally ill.

NURSING ROLES AND

RESPONSIBILITIES

We need to understand what are the

persons values in life, what he
perceives a quality life, personal
beliefs on dying/ concerns in dying.
Know our states statutes that guide
and govern advance directives
Be aware of the policies and
procedures regarding advance
directives where we work
Tilden (2000) urges us to complete
our own advance directives

For the purpose of :

1. Reflecting on our own values,
beliefs, and concerns
associated with end-of-life
issues
2. To learn more of the specific
forms and processes involved
3. To have more empathy with
patients going through this
process

 Discuss the advance directives

to patients family if limited
explanations could be done to
patients themselves.
Be familiar with our patients
directives for care and to
ensure that care is consistent
with the patients wishes.
Inform other health team
members if the