Patient Rights at the End of Life: The Ethics of Aid-in-Dying.

PURPOSE/OBJECTIVES: The end-of-life needs and desires of patients, whether it is related to a terminal illness or age-related end-of-life physiological function, can vary from patient to patient. Each dying patient's case should be approached in an individual and patient-centered fashion while supporting the dying patient's desired preferences related to end-of-life treatment. This serves to recognize the dying patient's individual rights related to self-determination of preserving his or her dignity during the end-of-life process. As the U.S. population continues to age at the fastest pace in history, it is vital for end-of-life patients and their family members, health care providers, and lawmakers to consider how health policy can drive legislation that supports the dying patient's right to express his or her dignity and own end-of-life desires related to aid-in-dying by allowing health care providers to legally provide physician-assisted health (PAD) and death with dignity (DD) the end-of-life care dying patients prefer. PRIMARY PRACTICE SETTING(S): Palliative, hospice, and long-term care. FINDINGS/CONCLUSIONS: When state laws do not support a terminally ill person's ability to make his or her own end-of-life decisions based on his or her own preferences and desires related to PAD and dignity in dying, there can be moral conflictions with the existing ethical principles that can contribute to additional distress and anxiety in the terminally ill patient. Not allowing the terminally ill patient the legal right to choose his or her preferences and desires at the end of life goes against the freedom of the patient to choose. The aging population is growing quickly, and people are living longer, which means the frail elderly in their final stages of death due to multisystem organ failure might also desire to have the option of PAD that supports dignity in dying. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Case managers are an instrumental and integral part of the end-of-life care team. They are held to the same standard of practice as clinical care providers when it comes to promoting the biomedical ethical points autonomy, beneficence, nonmaleficence, justice, and fidelity. Following these ethical principles is critical for case managers to consider when supporting the desires and preferences of terminally ill patients. Case managers should be involved in all the patient-centered decision making for a terminally ill patient's desire for DD and PAD. It is critical for case managers to follow their organization's defined code of professional conduct as well their specific professional organization and professional certifying body's defined code of ethics and conduct despite their personal convictions.

Hip Fracture in the Frail Elderly: Making the Case for Early Integration of Palliative Care and Timely Hospice Referral.

With the projected increase of an aging population in the upcoming decades, coupled with increasing elderly longevity, the incidence of hip fractures among this vulnerable population is expected to grow. Current evidence reveals high mortality rates within 6 months to 1 year among frail elderly patients who suffer hip fracture. In addition, the presence of multiple chronic conditions negatively impacts mortality rates in this vulnerable population. The purpose of this article is to discuss both the importance of integrating early palliative care and the appropriateness for hospice referral among frail elderly hip fracture patients. Moreover, the role nurses' play in early recognition of the need for palliative and/or hospice services among this vulnerable population will be explored.

The Epidemiology of Methicillin-Resistant Staphylococcus aureus in Orthopaedics.

In the specialty of orthopaedics, methicillin-resistant Staphylococcus aureus (MRSA) is a major contributor to infections of the soft tissues, surgical sites, and joints, in addition to increasing disability, mortality, and healthcare costs. Inappropriate prescribing and misuse of antibiotics have led to bacterial resistance and the rapid emergence of MRSA. It is imperative for healthcare providers and facilities to improve quality, promote safety, and decrease costs related to MRSA infections. The healthcare profession and society as a whole play an important role in minimizing the transmission of pathogens, reducing the incidence of MRSA infections, and decreasing the development of future antibiotic resistant pathogens. This article discusses the epidemiology of MRSA and describes evidence-based guidelines pertaining to the prevention, minimization, and treatment of MRSA-related infections. Specific application to orthopaedics are discussed in the context of patient risk factors, perioperative and postoperative prophylaxis, and current trends regarding education and reporting strategies.