Services

Tara Adyanthaya - TLAEthics.com

Tara Adyanthaya, J.D.,
MBE (Master of Bioethics)
404-723-8272
tara@tlaethics.com

What TLA Can Do:

Legal and Ethics Education

I have been a licensed attorney in Georgia for over 16 years with experience representing healthcare providers and institutions in diverse and complex matters. I have given countless lectures, seminars, and classes on issues related to all facets of the intersection of law and medicine, including at the Emory Center for Ethics, the Emory School of Medicine, the Emory School of Law, the Walter F. George School of Law, hospitals, physician practices, nursing teams and departments, social work department meetings, and conferences.

Topics have included, but are not limited to:

  • Legal Issues in Clinical Ethics Consultation
  • Capacity and Consent
  • Legal and Ethical Issues Related to Resuscitation An Overview of Georgia Law and Case Discussion
  • Trinitas Hospital v. Betancourt: Emotions in Ethical Analysis and Legal Outcomes
  • Hospice and Palliative Medicine Education: Legal Issues at the End of Life
  • Ethical Considerations for Compliance Officers
  • Legal Issues at End of Life
  • Advance Directives
  • Nurse Liability Issues
  • Legal Issues in Social Work
  • The Empowered Caregiver: Advance Care Planning
  • Against Medical Advice Discharges
  • Behavioral Contracts
  • Involuntary Commitments (Form 1013/2013)
  • Breaking Through Intractable Disputes
  • Balancing Patient Rights with Professional Obligations
  • Charting Clinical Ethics Consultations
  • Clinical Ethics and Managing Legal Risk
  • Physician Orders for Life Sustaining Treatment

If you have a particular area of concern not listed here, please call so we can discuss whether I have expertise that would enable me to put together a class on your area of interest.

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Advance Care Planning

I can assist you with Advance Care Planning. Advance Care Planning is the process through which a person explores his/her personal values to provide guidance for making future healthcare decisions if (s)he is unable to participate. The goal is to have a legally binding document that provides meaningful direction for decision making, which is commonly known as an Advance Directive. This guidance can and should include naming a Health Care Agent to act as a surrogate decision maker if you lose decision making capacity and a Living Will that discusses your values and how you would decide on specific treatments.

Georgia has an approved form that you can use.

Using this form is not necessary so long as you meet legal requirements for a valid Advance Directive.

Designating a Health Care Agent is particularly important if the person whom the law would automatically appoint has different values than you or is not the person you want making your decisions for you for whatever reason. In addition to making decisions about treatment and placement, a healthcare agent can make autopsy, organ donation, body donation, and final disposition of your body if you grant that authority. Please note that this power does not reside in a person to whom you may have given financial or other powers of attorney unless your document specifically grants health care powers of attorney.

You should talk to your healthcare agent about this important role and be sure to give him/her and your usual physician a copy of your Advance Directive.

The Living Will portion of an Advance Directive is used to state your treatment preferences if you have a terminal condition or if you are in a state of permanent unconsciousness. An Advance Directive becomes effective only if you are unable to communicate your treatment preferences. You should talk to your Health Care Agent about your wishes so (s)he is clear about what you would want. Ideally, you would also speak with your family and others close to you about your treatment preferences.

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Clinical Ethics Consultation

The goal of clinical ethics consultation is to facilitate patients being provided treatment and care that is in their best interests and consistent with their personal values and ethical standards. Health care environments are increasingly complex and navigating the issues requires a multi-disciplinary skill set that enables participants to communicate effectively and efficiently.

Ethics consultation can:

  • assist interested parties to identify values and treatment goals
  • identify a range of options to meet those goals
  • educate interested parties about the process so that they can more effectively address ethical concerns in the future
  • identifying ethics conflicts or questions
  • facilitate communication and consensus
  • review and design policies relating to patient care and treatment that implicates matters of ethical concern
  • clarify medical facts that impact goals and treatment
  • assist in resolving conflicts
  • provide assistance, training, and education to ethics committees, care teams, individual providers, and administration

 

I can provide individual case consultation, consultation while accompanying providers on rounds, and advise ethics committees and subcommittees.

Examples of ethical issues that arise include:
  • Patient Decision Making Capacity
  • Surrogate Decision Making (Who, What, How, And Why)
  • Informed Consent
  • Disclosure Obligations
  • Confidentiality
  • End-Of-Life Decision Making
  • Advance Care Planning
  • Forgoing Life Sustaining Treatment
  • Medical Futility
  • Medical Records Documentation
  • Ethics Committee Structure and Implementation
  • Rejection of Provider Treatment Recommendations
  • Appropriateness of DNAR Orders
  • Decision Making relating to Physician Orders for Life Sustaining Treatment
  • Transfer to Hospice Care
  • Determination of Brain Death
  • Persistent Vegetative States
  • Coma
  • Artificial Nutrition and Hydration
  • Reproductive Decision Making
  • Cultural and Religious Issues Impacting Care
  • Conflict Management
  • Rationing
  • Disclosure Issues
  • Peer Review Issues
  • Issues relating to HIV testing and treatment

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Mediation

Mediation is a private, voluntary process in which a third-party neutral facilitates communication among interested parties to assist in decision making that is mutually agreeable. As a process, it can improve relationships and clarify misunderstandings and miscommunications caused by poor communication; busy schedules; and anxious, overburdened, and tired participants. It is an effective tool that can save all interested persons time, money, and unnecessary anxiety that litigation brings.

Unlike the court process, mediation does not attempt to establish who is right or impose solutions on parties, Rather, the intention is to identify the goals and priorities of all interested parties, generate and explore options for achieving stated goals, clarify the facts and each party’s experiences, and to document any shared decisions.

For mediation to work, all decision makers must be willing to participate. This means the patient, or if the patient does not have capacity, his or her surrogate as well as the facility and the attending physician and other members of the care team who have a stake in the outcome all must be willing to participate. I require that all parties to the mediation sign a Mediation Agreement that sets forth the understandings needed for a successful mediation.

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What TLA Cannot Do:

I cannot impose my personal values on you. An important part of ethical competence is being able to separate one’s own values from those of the patient and family. I may have opinions, but those opinions do not matter in the context of the choice that must be made by that patient, family, and care team.

I cannot make decisions for you. My goal is to provide you with information that can be helpful in making the decisions you must make. I facilitate conversations among interested parties, provide information and context from research and experience, educate on the legal parameters that guide decision making, and help explore options that may be available. Ultimately patients, families, and members of care teams must live with their decisions, so it is important that these decisions be their own and not mine.

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