End of Life Ethics Flashcards
list the medical standards for death
- total cerebral function, usually assessed by EEG as flat-line
- spontaneous function of the respiratory system
- spontaneous function of the circulatory system
- brain death: irreversible brain damage as manifested by absolute unresponsiveness to all stimuli, absence of all spontaneous muscle activity, including respiration, shivering and an isoelectric EEG for 30 min
- all in the absence of hypothermia or intoxication by CNS depressants
a person can be legally dead even if their _____ continues to function, which was determined by the _____
a person can be legally dead even if their cardiopulmonary system continues to function which was determined by the Uniform Determination of Death Act (UDDA)
describe an advance directive and the 4 main types
- an advance directive is a document by which a person makes provision for health care decisions in the event that, in the future, he/she becomes unable to make those decisions
- the main types of advance directives are:
- living will
- durable power of attorney for health care
- combination advance directive
- protective medical decisions document (PMDD)
describe a living will
- oldest type
- a signed, witnessed (or notarized) document called a “declaration” or “directive”
- most delcarations instruct an attending physician to withhold or withdraw medical interventions from its signer if he/she is in a terminal condition and is unable to make decisions about the medical treatment
- attending physician might interpret the signers wishes and values differently
- family members have no legal standing to interpet the meaning of the directive
describe a durable power of attorney for health care
- the signer designates an agent to make health care decisions if the signer is temporarily or permanently unable to make such decisions
- important that the signer carefully discusses his/her values, wishes and instructions with the agent before
- does not require that the signer have a terminal condition
describe a combination advance directive
- contains specific written directions that are to be followed by a named agent
- since it’s impossible to predict all circumstances, specific directions may severely limit the discretion and flexibility that the agent needs and may restrict the agent’s authority in a way the signer did not intend
- the specific written directions may not be altered through discussions between the signer and the agent; any changes necessitates a new document
describe a protective medical decisions document (PMDD)
- in the PMDD the signer names a trusted person to make health care decisions in the event that the signer is temporarily or permanently unable to make such decisions
- specifically prohibits assisted suicide and euthanasia
describe a patient’s right to refuse life-saving treatment
-
mentally competent adults generally have the right to refuse medical treatment except in cases of compelling state interest
- the patient can understand the risks and benefits of the proposed treatment or refusal of treatment
- courts have upheld the right of an adult to refuse potentially life-saving medical treatment on religious grounds, unless the individual is:
- mentally incompetent
- the parent and sole provider of young children
- a pregnant woman
list the states interests
- preservation of life
- prevent suicide
- protect third parties
- integrity of medical profession
describe passive vs. active physician assisted suicide
passive = allowing the patient to die
active = causing the patient’s death
describe the arguments in favor of PAD
- respect for autonomy: decisions about time and circumstances of death are personal; competent people should have right to choose the timing and manner of death
- justice: competent, terminally ill patients have the legal rights to refuse treatment that will prolong their deaths; those suffereing but do not have the option of refusal have the same rights–PAD is their only option
- compassion: suffering means more than pain, physical, existential, social and psychological burdens; PAD may be a compassionate response to unremitting suffering
- individual liberty vs. state interest
- honesty and transparency
describe the arguments against PAD
- sanctitiy of life
- passive vs. active distinction
- potential for abuse
- professional integrity
describe the 2 laws for surrogate decision makers
- hierarchy surrogate consent laws
- consensus surrogate consent laws (Colorado and Hawaii)
- consensus statutes require that all reasonably available “interested persons” come to a consensus about who should act as the decision-maker
who cannot be a surrogate decision maker?
- your treating healthcare provider cannot be your healthcare surrogate
- an employee of a treating healthcare provider UNLESS you are related to that employee
- an owner, operator or administrator of a healthcare facility serving you cannot be your healthcare surrogate
- an employee of an owner, operator or administrator of a healthcare facility cannot be your healthcare surrogate UNLESS you are related to them
representative of never competent patient cannot _____ or _____ from a patient unless the patient is in an end-stage condition or permanently unconscious without first petitioning the court
representative of never competent patient cannot withhold or withdraw life sustaining medical treatment from a patient unless the patient is in an end-stage condition or permanently unconscious without first petitioning the court
