Medical Social Work: Legal Issues in End-of-Life Care

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Discussion: Case Studies of Legal Issues

Medical social workers play an integral role as
support for patients and their families at the end of a patient’s life.
Most physicians are not equipped to handle the emotional aspects at the
end of life. Therefore, more often than not, medical social workers are
the principal health care professional involved in educating, mediating,
and coordinating end of life plans. In this capacity, medical social
workers are charged with informing patients and their families about
end-of-life decisions and providing counseling around these issues.
Medical social workers must understand the terminology, technology, and
legal issues that can dictate end-of-life care.

Consider the following cases:

End-of-Life Care: Case 1

    Roger is a 43-year-old African American male
    diagnosed with HIV/AIDS and renal failure. He was recently admitted to
    the intensive care unit and put on a ventilator due to medical
    deterioration. The doctors inform his wife that there is no chance that
    his condition will improve and explain that he is being kept alive by
    the machines. Roger’s wife is distraught but knows that Roger did not
    want to be kept alive by a machine. The medical social worker goes to
    Roger’s chart and finds his medical power of attorney. Roger’s wife is
    listed as his agent; however, the document was not signed by two
    witnesses as required.

End-of-Life Care: Case 2

    Margaret is a 72-year-old female with severe
    cardiovascular disease. She is admitted to the hospital after a stroke.
    There is no indication that she will recover and, if so, to what level
    of functioning. The doctors have informed her family that she is
    experiencing cardiac issues that might lead to heart failure. Should
    this happen, the doctors will have to take efforts to resuscitate her.
    The medical social worker and the doctor meet with the family to discuss
    a do not resuscitate order. The family is completely overwhelmed. They
    do not fully understand what the doctor is saying and they are in
    disagreement about what to do.

To prepare for this Discussion, review this week’s resources including the case studies. Select one of the cases. Think about the end-of-life issues including living wills or medical power of attorney.

By Day 3

Post an explanation of how you
as a medical social worker would handle the case you selected. Explain
the services you might offer to the family within the applicable laws
and your scope of practice. Explain the methods and practices you might
employ to educate this family regarding the legal issues surrounding the
case. Then, explain the purpose, benefits, and legal ramifications of
living wills, medical power of attorney, and advance directives.
Finally, explain the advocacy role you might play on behalf of the
patient and patient’s family in this case.

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