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LAW Policy Practicum: Endstage Decisions: Health Directives in Law and Practice

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LAW 413Z

Policy Practicum: Endstage Decisions: Health Directives in Law and Practice

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[ Litigation ] Health Law: General

Why it is relevant for ...

[ Litigation ] as a Related Elective for those interested in Public Policy : A policy practicum is a great choice for skills-based training in the range of methods available to effect changes in the law. Some policy labs, like this one, offer students an opportunity to do research on the scope of a problem not adequately addressed in current law or regulation. Students develop proposals for new or revised regulation based on problems identified in their research. This course is a good choice for students interested in health policy and those expecting to serve clients in the health care industry. Its focus is on the effectiveness of health directives and “end-of-life” decisions. Stanford Hospital and Clinics is the client to whom research and policy recommendations will be addressed.

General course Description:

Medical decisions toward the end of life can be crucial and difficult for patients, doctors, and the families of patients. Law and medicine have been struggling to find ways to strike a balance between what the patients might want (or say they want), and what makes medical, economic, and ethical sense. People have been encouraged to fill out "Advanced Health Care Directives," which give guidance to doctors and surrogates (usually a family member) on what to do when faced with end-of-life dilemmas. Another form, adopted in just over half the states (including California) is the POLST form (Physician Orders for Life-Sustaining Treatment). The two types are supposed to complement each other, but they are different in important ways. The Advanced Health Care Directive expresses what a person wants, or thinks she wants, and/or appoints a surrogate, in case the patient is unable to express her wishes. Anybody can fill out a Directive, at any time of life. Ideally, a copy goes to the surrogate, if one is appointed, and another to the primary care physician. The POLST form is meant for people who are seriously ill. It is a one page form, printed on bright pink paper. It is signed by patient and doctor. The directives (for example "no artificial nutrition by tube") are supposed to be controlling; the patient, of course, can change her mind; but there is no surrogate. It is an agreement between the patient and the doctor. Who uses these forms? How effective are they? To what extent and in what situations are they useful? In what situations are they not useful? Can they be made more useful and, if so, how? There has been research on the subject; and a major report on the end-of-life issue (originally due out in December) will be released this summer. The class will look at some of this literature, but the main point will be to find out what local hospitals and nursing homes are doing. Students will conduct interviews with doctors, nurses, and other health care specialists in order to find out what one might call the living law of the Directive and of Polst. The aim is to get a more realistic picture of the situation in the area: how are these forms used, when are they used, what has the experience of health care professionals been; perhaps also some insight into the experience of patients and family members. The ultimately goal would, one hopes, be policy recommendations for improvements in the forms themselves, and the laws relating to the forms, along with recommendations for ways to improve the way the forms are or can be used; or whether some entirely different approach to the problem might be needed. Stanford Hospital and Clinics will be the client in researching and addressing the above questions. Elements used in grading: Final Paper. NOTE: Students may not count more than a combined total of eight units of directed research projects and policy lab practica toward graduation unless the additional counted units are approved in advance by the Petitions Committee. Such approval will be granted only for good cause shown. Even in the case of a successful petition for additional units, a student cannot receive a letter grade for more than eight units of independent research (Policy Lab practicum, Directed Research, Senior Thesis, and/or Research Track). Any units taken in excess of eight will be graded on a mandatory pass basis. For detailed information, see "Directed Research/Policy Labs" in the SLS Student Handbook. CONSENT APPLICATION: To apply for this course, students must complete and e-mail the Consent Application Form available on the SLS Registrar's Office website (see Registration and Selection of Classes for Stanford Law Students) to the instructors. See Consent Application Form for submission deadline.

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