Withholding and Withdrawal of Life Sustaining Treatment Policy

Withholding and Withdrawal of Life Sustaining Treatment Policy

Effective Date: [Original NPP Date]
Revised Date: [Current Date]

Goal

Uphold the State and Federal Law concerning withholding and withdrawal of life-sustaining treatment. This ensures each resident’s right to participate in and direct his/her health care decisions, including the right to withhold and withdraw life-sustaining treatment where a terminal condition and/or state of permanent unconsciousness exists. This facility is committed to providing the highest quality of care in a dignified atmosphere where each resident’s right of self-determination is respected.

Policy

I. It is the policy of this facility to provide, to the fullest extent possible, for each resident's physical, emotional, and social well-being in a safe and secure environment. This includes the provision of life-sustaining medical treatment available in the long-term care setting, including adequate nutrition and hydration for all residents.

II. We respect the rights of the capable resident who is in a “terminal condition” to refuse life-sustaining treatment, including artificially supplied nutrition and hydration. In such cases, we will provide comfort measures and pain alleviation, utilizing nursing procedures appropriate to end-of-life conditions.

III. Prior to admission, the facility Admissions Coordinator will provide the resident or responsible party with the facility policy and other pertinent information concerning end-of-life treatment decisions and will encourage residents to define their wishes in advance. Where appropriate, facility staff will also confer with all available and interested family members about life-sustaining/right-to-die matters.

IV. It is also the policy of this facility to honor a resident’s advance directives where the resident is incapacitated and unable to make such determinations. This applies to withholding and withdrawal of life-sustaining treatment only where a terminal condition and/or permanent state of unconsciousness exists, as defined by law. Beneficial medical treatment will be provided to incompetent residents who are not deemed to be in a terminal condition or permanently unconscious.

V. This facility also acknowledges the right of capable residents who are not in a terminal condition or a state of permanent unconsciousness to refuse medical treatment. However, refusal of treatment by such a resident may result in discharge if, in the opinion of the attending physician and/or Medical Director, their refusal of treatment seriously jeopardizes their health and/or safety or the health and/or safety of others. In this case, the facility will actively assist the resident, next of kin, and/or legal guardian in finding placement elsewhere.

VI. Residents who are in the final stage of an incurable and irreversible medical condition, which without the administration of a life support system will result in death in a relatively short time in the opinion of the attending physician, are considered to be in a “terminal condition.”

VII. “Permanently Unconscious” includes coma and a persistent vegetative state, meaning an irreversible condition in which the individual is at no time aware of himself or the environment and shows no behavioral response to the environment, as determined by a neurologist.

VIII. This facility maintains procedures to be followed through the process of determining when and if withholding and withdrawal of life-sustaining treatment is appropriate; and, if not appropriate, what procedures to follow.

IX. It is our policy not to discriminate in any way against a resident or applicant for admission based on whether he or she does or does not have an advance directive.

X. This facility accepts a “no hospitalization order” as it relates to the progression of and complications due to the terminal condition. Only palliative care will be given.

XI. In cases where there is a conflict or disagreement among caregivers concerning a particular resident, the case should be referred to the Ethics Committee who will make recommendations concerning disposition.

XII. In cases where a terminal condition is documented and the decision has been made to forego aggressive nutritional support, the DNS should review the record for appropriate documentation that the resident or family/responsible party has been fully informed of the risks and consequences of their decision. Also, physician documentation that the resident’s wishes, either expressed directly or through the family/responsible party, have been considered and that the physician agrees that this is the most appropriate medical course of action. The Interdisciplinary Care Plan is to be updated to include the monitoring and comfort measures to be provided to the resident.

References

• Centers for Medicare & Medicaid Services. State Operations Manual, Appendix PP - Guidance to Surveyors for Long-Term Care Facilities. [Link to current CMS SOM]
• CMS Requirements of Participation for Long-Term Care Facilities. [Link to current guidelines]