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Chapter 33. Legal, Ethical, and Policy Issues

William E. Reichman, M.D.; Joel E. Streim, M.D.; Jason H.T. Karlawish, M.D.; J. Pierre Loebel, M.D.
DOI: 10.1176/appi.books.9781585623754.399682

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With the explosive growth anticipated in the ranks of the elderly over the coming decades, clinicians, educators, researchers, patient advocates, and policy makers have become increasingly focused on society's ability to meet the anticipated health care needs of older adults. This focus has involved ongoing reexamination of the financing structure and workforce dedicated to supporting the health care of the nation's elderly population. In addition, increasingly open dialogues have occurred regarding other important and related social themes, including the ethical issues that must be confronted and managed in caring for patients at the end of life (Institute for Health and Aging 1996). Reform and redesign of health care services directed to the care of an aging and increasingly infirm population is a dynamic and highly politicized process. The same holds true for the social and ethical dimensions of geriatric health care. In the midst of this evolving and complex process, one conclusion has been widely embraced by all especially interested stakeholders: the current U.S. mental health care system serves older patients with mental disorders poorly and is largely unprepared to meet what has been described as an upcoming crisis (Jeste et al. 1999).

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Table Reference Number
Table 33–1. Fundamental concerns in providing end-of-life care
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Table 33–2. Areas in end-of-life care for consideration by the psychiatrist
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Table 33–3. Questions to structure the end-of-life discussion with the patient
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Table 33–4. Abilities required for decision-making capacity

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The Omnibus Budget Reconciliation Act of 1987 (OBRA-87) made a number of changes to how Medicare covered outpatient psychiatric services. Which of the following changes occurred as a result of this legislation?
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Between the years of 1990 and 2000, a number of changes occurred in the demographic characteristics of veterans receiving mental health services from the Department of Veterans Affairs (VA). Which of the following was one of these changes?
3.
Numerous reviews and professional organizations' position statements have set forth guidelines for what constitutes good care at the end of life. Some common fundamentals have emerged. All of the following are examples of these fundamentals except
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