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

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:

• Make a determination of decisional capacity based upon the evidence-based Appelbaum model for decisional capacity.
• 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.
• 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.
• 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.