Ethics/Legal

(SA11) Interdisciplinary Ethics Panel Approach to End-of-Life Decision-Making for Unbefriended Nursing Home Residents

Saturday, March 11, 2023

2:00 PM – 3:00 PM ET

Room: 116/117

CME: (1) MOC: (1) CMD Management: (1) Nursing Contact Hours: (1) AAFP: (1)

This session, based on our recent Journal of Clinical Ethics article, presents an Interdisciplinary Ethics Panel approach to end of life (EOL) decision-making for unbefriended nursing home (NH) residents, lacking decisional capacity, via a 9-step algorithm, developed for this purpose. It reviews outcomes of 3 quality-of-care (QOC) initiatives conducted in our facility, a public NH home in NYC with a large unbefriended population, which indicates this approach promotes advance-care planning in this subpopulation. It also reviews another QOC initiative when this approach was successfully applied to EOL decision-making for NH residents with surrogates during the COVID-19 pandemic. Upon completion of this session, participants will be able to apply this approach in situations as described.

Learning Objectives:

At the completion of this session, learners will be able to:

Upon completion of this session, participants will be able to make a determination of decisional capacity based upon the evidence-based Appelbaum model for decisional capacity.
Upon completion of this session, participants will be able to describe and explain the psychosocial determinants of health prevalent among the unbefriended in this large public nursing home and how these factors influence the end-of-life decision-making process.
Upon completion of this session, participants will be able to apply this novel interdisciplinary ethics panel approach to the end-of-life decision-making for unbefriended nursing home residents without decisional capacity, as well as to nursing home residents who lack decisional capacity but have surrogates.
Upon completion of this session, participants will be able to describe the major approaches to the end-of-life decision-making for the unbefriended without decisional-capacity in our country and to explain why the framers of the Algorithm for the Unbefriended selected an interdisciplinary team approach.

Session Chair/Speaker(s)

Howard J. Finger, DO (he/him/his)

Clinical Ethics Consultant
New York, New York

Slides PDF

Speaker(s)

Rani Rao, MD, CMD (she/her/hers)

Chief Medical Officer
New York, New York
Ravindra Amin, MD

Chief of Psychiatry
Roosevelt Island, New York