9.4 Palliative Care and Hospice Legal Considerations
2 min read•july 24, 2024
Palliative care and hospice are crucial aspects of end-of-life care. They focus on improving quality of life for patients with serious illnesses, offering symptom relief and stress reduction. Understanding the legal framework and ethical considerations is essential for healthcare providers.
The plays a key role in providing access to end-of-life care. , covered services, and ethical considerations like and pain management are important factors in delivering compassionate and legally compliant care to terminally ill patients.
Understanding Palliative Care and Hospice
Definition of palliative care vs hospice
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- Palliative care provides specialized medical care for serious illnesses focusing on symptom relief and stress reduction improves quality of life for patients and families can be administered alongside curative treatments (cancer, heart failure)
- Hospice care offers specific palliative care for terminally ill patients when curative treatments are no longer pursued typically for patients with life expectancy of 6 months or less emphasizes comfort and dignity in final stages (advanced cancer, end-stage dementia)
Legal framework for end-of-life care
- Federal regulations establish Medicare Conditions of Participation for hospice providers ensure HIPAA privacy and security rules compliance
- State laws and regulations dictate licensing requirements for hospice providers define scope of practice for healthcare professionals (nurses, social workers)
- Accreditation standards include for palliative care programs adhere to guidelines
- Legal considerations encompass and living wills designate healthcare power of attorney implement Do Not Resuscitate (DNR) orders
Medicare Hospice Benefit and Ethical Considerations
Medicare Hospice Benefit eligibility
- Eligibility criteria require Medicare Part A enrollment necessitate certification of terminal illness with life expectancy of 6 months or less mandate election of hospice care instead of other Medicare benefits for terminal illness
- Covered services include:
- Nursing care
- Medical equipment and supplies
- Prescription drugs for symptom control and pain relief
- Short-term inpatient care for pain and symptom management
- Home health aide and homemaker services
- Physical, occupational, and speech therapy
- Social work services
- Dietary counseling
- Grief and loss counseling for patient and family
Ethical considerations in end-of-life care
- Informed consent requires disclosure of treatment options and risks upholds patient's right to accept or refuse treatment mandates documentation of consent process
- Pain management balances pain relief with potential side effects addresses legal considerations of opioid prescribing (morphine, fentanyl) tackles concerns about addiction or hastening death
- Withholding or withdrawing treatment respects patient's right to refuse life-sustaining treatment provides legal protections for healthcare providers following advance directives weighs ethical considerations in artificial nutrition and hydration
- End-of-life decision-making respects patient addresses potential conflicts between patient wishes and family desires considers ethical implications of palliative sedation (terminal sedation)
Key Terms to Review (19)
Advance directives: Advance directives are legal documents that allow individuals to outline their preferences for medical treatment in case they become unable to communicate their wishes due to illness or incapacity. They empower patients to maintain control over their healthcare decisions and ensure their values and preferences are respected, especially during critical times. This concept is crucial for protecting patient rights and addressing ethical dilemmas that can arise in clinical practice, particularly for vulnerable populations and in palliative care settings.
Autonomy: Autonomy refers to the right of individuals to make informed, independent decisions about their own lives and healthcare. This principle is central to ethical and legal standards in healthcare, ensuring that patients have the freedom to choose their treatments based on their values, preferences, and understanding of their medical conditions.
Beneficence: Beneficence is the ethical principle that obligates healthcare providers to act in the best interest of patients, promoting their well-being and preventing harm. It emphasizes actions that contribute positively to the health and welfare of individuals, and serves as a foundation for various aspects of healthcare practice and legal considerations.
Best interest standard: The best interest standard is a legal principle used to guide decisions made on behalf of individuals who are unable to make informed choices for themselves, especially in medical contexts. This standard emphasizes the need to prioritize the well-being and preferences of the individual, taking into account their values, needs, and unique circumstances when making healthcare decisions, particularly during end-of-life care and palliative settings.
Cruzan v. Director, Missouri Department of Health: Cruzan v. Director, Missouri Department of Health is a landmark U.S. Supreme Court case from 1990 that addressed the right to refuse medical treatment and the standards for determining whether a patient wishes to withdraw life-sustaining treatment. This case reinforced the importance of advanced directives and informed consent in medical settings, impacting the legal landscape around life-sustaining treatment decisions, including those made through Physician Orders for Life-Sustaining Treatment (POLST) and considerations in palliative care and hospice settings.
Do Not Resuscitate (DNR) Order: A Do Not Resuscitate (DNR) order is a legal document that prevents healthcare providers from performing cardiopulmonary resuscitation (CPR) in the event of a patient's cardiac or respiratory arrest. This order reflects the patient's wishes regarding end-of-life care, emphasizing the importance of respecting patient autonomy and informed consent. DNR orders are particularly relevant in palliative care and hospice settings, where the focus is on providing comfort and quality of life rather than aggressive medical interventions.
Eligibility Criteria: Eligibility criteria refer to the specific conditions or requirements that individuals must meet to qualify for a particular service or benefit. In the context of palliative care and hospice, these criteria help determine which patients are appropriate for receiving specialized end-of-life care, ensuring that resources are allocated to those who need them most.
Informed Consent: Informed consent is a legal and ethical requirement in healthcare that ensures patients have the right to make knowledgeable decisions about their medical treatment. It involves providing patients with clear information about their diagnosis, treatment options, risks, benefits, and alternatives so they can voluntarily agree to a procedure or intervention.
Joint commission standards: Joint Commission standards are a set of rigorous quality and safety benchmarks established by the Joint Commission, an independent, non-profit organization aimed at improving healthcare for the public. These standards provide guidelines for healthcare organizations to ensure effective patient care, safety, and operational efficiency, thus influencing the standard of care and ethical practices in healthcare settings.
Living Will: A living will is a legal document that allows an individual to outline their preferences for medical treatment in the event they become unable to communicate their wishes due to illness or incapacity. This document is crucial for guiding healthcare decisions and ensuring that a person's values and desires are respected when they cannot advocate for themselves. It plays an important role in end-of-life decision-making and is a vital type of advance directive, which ultimately influences the legal landscape surrounding palliative care and hospice services.
Medical futility: Medical futility refers to interventions that are unlikely to produce any significant benefit for the patient. In the context of healthcare, it raises ethical and legal questions about the appropriateness of certain treatments, especially when they may prolong suffering without a reasonable chance of recovery or improvement in quality of life. Understanding medical futility is crucial in palliative care and hospice settings, where the focus shifts from curative treatments to enhancing comfort and dignity in end-of-life care.
Medicare Hospice Benefit: The Medicare Hospice Benefit is a specific program under Medicare that provides comprehensive care for terminally ill patients who have a life expectancy of six months or less. This benefit covers a range of services, including pain management, symptom control, and emotional support for both patients and their families, emphasizing a quality of life rather than curative treatment. It also ensures that patients receive care in a setting of their choice, typically at home or in a hospice facility.
National Hospice and Palliative Care Organization (NHPCO): The National Hospice and Palliative Care Organization (NHPCO) is a leading organization that provides resources, education, and advocacy for hospice and palliative care providers across the United States. It aims to improve the quality of life for patients with serious illnesses by promoting access to compassionate care and ensuring that healthcare policies support these vital services.
Patient Self-Determination Act: The Patient Self-Determination Act (PSDA) is a federal law enacted in 1990 that mandates healthcare providers to inform patients about their rights to make decisions regarding their own medical care, including the right to accept or refuse treatment. This law aims to ensure that patients are aware of their options and encourages them to participate actively in their healthcare decisions, fostering informed consent, ethical decision-making, and the use of advance directives.
Patient-centered care: Patient-centered care is an approach in healthcare that prioritizes the individual needs, preferences, and values of patients in their treatment process. This model emphasizes active collaboration between patients and healthcare providers, ensuring that patients are well-informed and actively involved in decisions regarding their care. By focusing on the unique experiences and perspectives of patients, this approach fosters a more holistic view of health and wellbeing.
Right to pain management: The right to pain management is the ethical and legal obligation of healthcare providers to adequately assess and address patients' pain through appropriate interventions. This right emphasizes the importance of ensuring that patients, especially those in palliative care or hospice settings, receive comprehensive treatment aimed at alleviating suffering and enhancing their quality of life.
Right to Refuse Treatment: The right to refuse treatment is a legal and ethical principle that allows patients to decline medical interventions or procedures, even if such refusals may lead to negative health outcomes. This principle empowers individuals to make autonomous decisions about their healthcare, reflecting personal values, beliefs, and preferences, and it intersects with various aspects of medical ethics and patient rights.
Substituted judgment: Substituted judgment is a legal and ethical principle used when a person is unable to make decisions for themselves, typically due to incapacity or illness. This principle allows a surrogate decision-maker to make choices based on what the individual would have decided if they were capable, reflecting their values and preferences. It emphasizes the importance of honoring the autonomy of patients even when they cannot voice their wishes directly.
Washington v. Glucksberg: Washington v. Glucksberg is a landmark U.S. Supreme Court case decided in 1997 that addressed the constitutionality of physician-assisted suicide. The Court ruled that the right to die with dignity was not a fundamental right protected by the Constitution, thereby impacting the legal landscape around end-of-life decisions and individual autonomy in medical care.