A good death Flashcards
(30 cards)
What is the ethical basis of palliative medicine?
To improve the quality of life of patients and their families facing life-threatening illness through the prevention and relief of suffering
This includes early identification and impeccable assessment and treatment of pain and other problems.
What are common notions of a ‘good death’?
- Pain free
- Dignified
- Timely
- Goodbyes have been said
- Affirms the meaning of life lived
What is the significance of the modern hospice movement?
It addresses the displacement of care from medical vision, especially in caring for the dying
Initiated by Cicely Saunders in 1967 with St Christopher’s Hospice.
What are the key aspects of the hospice philosophy?
- Acknowledgement of the dying process
- Honest communication with patients
- Caring for the whole person
- Multidisciplinary approach
- Evidence-based palliative treatments
When was palliative care recognized as an official medical specialty?
In Great Britain and Ireland in 1987
‘Hospice and palliative medicine’ was recognized by the American Board of Medical Specialties in 2006.
How can medicine negatively affect the quality of a person’s death?
- Overtreatment
- Undertreatment (especially of pain)
- Failure to communicate openly
- Insensitivity to what is important to the patient
What does palliative care recognize about the needs of patients and their families?
Their needs often intersect and connection at the end of life is crucial
This need became evident during the pandemic when families could not be with loved ones.
What is the definition of ‘existential pain’?
Pain that is influenced by non-physical factors, including anxiety over living and dying
It can significantly impact a person’s perception of suffering.
What does Cicely Saunders’ model of total pain include?
- Physical pain
- Emotional pain
- Social pain
- Spiritual pain
What is the importance of compassion in addressing suffering?
It is essential for effective patient care
‘The secret of the care of the patient is in caring for the patient.’ - Francis Peabody
What did the study by Kagawa-Singer find regarding subjective well-being?
Subjective well-being did not correlate with physical status among cancer patients
Many patients rated themselves as ‘fairly well’ or ‘very well’ despite their conditions.
How is acceptance of death viewed in palliative care?
It affirms life and regards dying as a normal process, intending neither to hasten nor postpone death
Acceptance is crucial for enabling agency.
What challenges exist in the process of acceptance of death?
- It is deeply personal
- Patients may prefer to ‘fight’
- Prognosis can be uncertain
- Patients may cling to unrealistic hopes
What are examples of life-extending treatments?
- Antibiotics
- Chemotherapy/radiotherapy
- Surgery
- Dialysis
- Organ transplant
- ICU admission
- Resuscitation
- Artificial food and hydration
What ethical implications arose from cases like Terry Schiavo?
- Examined the meaning of being alive or dead
- Relationship between duty of care and letting die
- Concepts of patient autonomy and sanctity of life
What is the relationship between suffering and control in palliative care?
Restoring a measure of control can be essential in relieving suffering
Advance care planning is one method to restore control.
What is the role of emotional and psychological engagement in palliative care?
Affective engagement is essential; distance and detachment are not possible
Understanding what is happening for patients is a vocational requirement.
Fill in the blank: The term ‘euthanasia’ translates to _______.
[good death]
What are critical concepts in the debate over assisted dying?
Patient autonomy, sanctity of life, futility
These concepts are essential in understanding the ethical implications surrounding assisted dying.
What does the phrase ‘postpone death’ imply in the context of medical treatment?
It suggests the actions taken to delay the inevitable end of life, often through aggressive medical interventions.
In ‘Being Mortal’, what does the character’s insistence on doing ‘everything’ signify?
A desire to pursue all possible treatments despite the risks and potential outcomes.
What does Atul Gawande suggest about spending final days in an ICU?
It is often viewed as a failure for most people, lacking closure and meaningful goodbyes.
What is a significant distinction between withholding treatment and euthanasia?
Withholding treatment recognizes that treatment will worsen the situation, while euthanasia judges that death is preferable to continued life.
What should doctors consider when deciding on curative treatment?
- Worthwhile treatment (harms vs benefits)
- Patient’s perspective
- Patient’s concerns
