**Legal Aid Society of Palm Beach County, Inc.**

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***Bioethics Law Project***

***BIOETHICS COLLABORATIVE FOR END-OF-LIFE EDUCATION, OUTREACH &
ADVOCACY***

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**Marnie R. Poncy, R.N., Attorney at Law**

2005 WHITE HOUSE CONFERENCE ON AGING

ASOLUTIONS FORUM@

Thank you for inviting The Bioethics Law Project of the Legal Aid
Society of Palm Beach County, Inc. to present this morning. The
Bioethics Law Project is now into its fourth year having been expanded
into a collaborative with Hospice of Palm Beach County, Inc., Hospice by
the Sea and the Palm Beach County Medical Society as the Bioethics
Collaborative for End-of Life Education, Outreach and Advocacy. This
Collaborative is funded by the Quantum Foundation and is, as far as we
know, a nation-wide first. The goal of the Bioethics Law Project has
been to serve as a bridge between the medical and legal communities
involved in end-of-life issues.

Historically, we have incorporated a three pronged approach: education,
intervention and advocacy.

Education in Advance Directives has been provided to professionals in
both medicine and law. Classes on the need for formulation of Advance
Directives for consumers have been given for all ages from high school
students to nursing homes residents. The curriculum reviews legal
history and status of patient rights of self determination, medical
technology at end of life, palliative care and hospice alternatives,
emotional and psychological perspectives and suggestions for alleviating
the problems.

Requests for assistance have come from hospital staff, nursing home
staff, patients, family members, hospital administration, physicians and
lawyers. Numerous situations have been resolved through engagement of
discussion between healthcare providers and families
\...\...\...\...basically, bridging the communication gap.

We have recognized a particular category of vulnerable elderly. The
un-befriended and incapacitated elderly person. These are people who are
completely alone at one of the most vulnerable times of their lives.
These are the folks who fall prey to continued reimbursable care, often
times regardless of benefit. No one can make the decision for these
patients to stop the unproductive effort. No one can sign them into a
palliative care program. No one can sign them into a hospice. As a
result of these particular interventions, the Bioethics Law Project has
gone to court on behalf of the un-befriended incapacitated
patients\...\...\....hence the advocacy piece.

The success of this project has been galvanized through active
engagement and collaboration with a variety of local agencies: Hospice
of Palm Beach County, Hospice by the Sea, Area Agency on Aging, State
Attorneys Task Force on Crimes against the Elderly, Alzheimer's
Community Care, Inc., Palm Beach County Health Department, Treasure
Coast Health Council, Omega, Department of Senior Services, The Public
Guardianship Program, Catholic Charities, Alpert Jewish Children and
Family Services and the State of Florida Ombudsmen to name a few.

Examples of the necessity for the multi discipline approach of nurse and
lawyer are reflected by two women represented in the past 6 months. Each
woman was coincidentally named Margaret. Each was in a nursing home with
a diagnosis of late stage dementia.

Maggie gave me an oral directive: she did not want a peg tube placed in
her abdomen Abelly@, she did not want to go to the hospital for such a
procedure; she wanted Hospice care so she could remain where she was.
AAfter all@, to quote her, AI=m 98 years old, who do they think they=re
kidding?@. The nursing home refused to accept her directive. Only upon
threat of a battery claim if the administrator persisted in the hospital
transfer prior to receiving court permission for hospice, and filing a
claim on her behalf, were her wishes followed.

The second Margaret had been in another nursing home for nearly two
years. She was non responsive and had a peg tube. She had been like this
for the entire two years in contradiction to the written expressed
wishes in her Advance Directive found on her chart. The nursing home had
been following contrary directions of her husband/surrogate who himself
had been declared to be legally incompetent prior to Margaret=s
admission. Court advocacy to have her written Advance Directive followed
with an admission to hospice was necessary.

Two ladies, two directives, two nursing homes, two end-of-life plans of
care thwarted, two heartbreaks\...\...\...\...\...\... two remedied.

In conclusion, the Bioethics Law Project appears to be responding to the
need identified in the SUPPORT Study to address the issue of end-of-life
care on a community level with a multi discipline approach. The future
for Palm Beach County residents looks even more promising because of
Quantum Foundation and the expansion of this project into a
collaborative for education, outreach and advocacy with Hospice Palm
Beach County, Hospice by the Sea and Palm Beach Medical Society.
Together we believe we can more than triple community education, expand
outreach into doctors= offices, and increase advocacy among elder law
attorneys.

For more information please contact:

Libby Spillane, Administrative Paralegal

Bioethics Law Project / Bioethics Collaborative for Education, Outreach
and Advocacy

Legal Aid Society of Palm Beach County, Inc.

423 Fern Street, Suite 200

West Palm Beach, Florida 33401

Phone: (561)655-8944 x 236

Fax: (561)655-5269

email: [lspillane@legalaidpbc.org]{.underline}

To access an Advance Directive, visit our website at
[www.legalaidpbc.org]{.underline} - click the Legal Services tab, go to
special programs, Bioethics Law Project and click on the education link