Chapter 9: Ethical Issues in End-of-Life Nursing Care

Question 1

Responsibility of Nurses Toward Suffering Patients:

Answer 1

Interpret patients’ suffering.

Minimize pain or distress.

Be mindful of need for compassion.

Console suffering patients.

Question 2

Responsibility of Nurses Toward Suffering Patients:

Principles of mercy

Answer 2

Duty not to cause further suffering

Duty to act to end existing suffering

Question 3

The Definition of Death: Uniform Determination of Death Act of 1981 (UDDA) addresses two types:

Answer 3

Whole-brain death

Cardiopulmonary death

Question 4

The Definition of Death: Uniform Determination of Death Act of 1981 (UDDA) addresses two types:

Whole-brain death:

Answer 4

Mechanical ventilation required to breathe

Question 5

The Definition of Death: Uniform Determination of Death Act of 1981 (UDDA) addresses two types:

Cardiopulmonary death:

Answer 5

Irreversible cessation of respiratory and circulatory processes

Question 6

The Definition of Death:

Higher-brain death: What state is it?

Answer 6

Persistent vegetative state- some brainstem functions intact

Question 7

The Definition of Death:

Higher-brain death: What is not required?

Answer 7

Mechanical ventilation not required

Question 8

The Ideal Death:

Death anxiety & avoidance: Dread of death..

Answer 8

Dread of death in the unconscious

Question 9

The Ideal Death:

Death anxiety & avoidance: What should you recognize?

Answer 9

Recognize the influence of death anxiety.

Question 10

The Ideal Death:

Death anxiety & avoidance: Yalom (1980)

Answer 10

individuals avoid death through immortality projects and dependence on a rescuer

Question 11

The Ideal Death: How to support a good death?

Answer 11

Focus on illness trajectory and palliative care.

Question 12

The Ideal Death: How to support a good death:

What does supporting good death do?

Answer 12

Minimizes suffering and promotes human dignity

Question 13

The Ideal Death:

Support good death: How does it vary?

Answer 13

Varies from person to person

Question 14

The Ideal Death:

Support ideal death how?

Answer 14

Support imaginative dramatic rehearsal.

Reconstruct the ideal death scenario.

Question 15

Advance Directives:

Answer 15

Written expression of wishes about medical care, whereas a conventional will/attorney only considers property

a general term encompassing all types of written wishes about medical care

Question 16

Advance Directives:

Living Will: What is it?

Answer 16

A legal document with medical instructions for specific situations, not just end-of-life

Question 17

Advance Directives:

Health Care Proxy

Answer 17

Another term for surrogate decision-maker

Question 18

Advance Directives:

Medical Orders for Life-Sustaining Treatments (MOLST):

Answer 18

a set of medical orders for patients with advanced illness who might die within 1-2 years; require long-term care services; or wish to avoid and/or receive specific life-sustaining treatments now

Question 19

Advance Directives: How should advanced directives be available? What does this mean?

Answer 19

Must be physically available to healthcare providers

Patients should bring with them to hospital, avoid keeping in safes/banks

Question 20

Advance Directives:

Nurses Role in Advanced Directive Planning:

Answer 20

Encourage honest discussions with patients and family

Use therapeutic communication

Educate re: written directive options

Question 21

Medical Futility

Answer 21

Medical futility is an unacceptable risk of harm for a poor chance of achieving any therapeutic benefit (the risks outweigh the benefits)

Question 22

What does Medical Futility relate to?

Answer 22

Relates to responsibility to benefit person as a whole

Question 23

Palliative Care:

Palliative Goals: What are they?

Answer 23

Relieve pain and suffering.

Question 24

Palliative Care:

Palliative Goals: What do they help with?

Answer 24

Help maintain dignity

Question 25

Palliative Care: What is the primary responsibility of nurses in Palliative Care?

Answer 25

Alleviation of pain/suffering Makes all palliative care an ethical concern

Question 26

Hospice: Is what kind of death? What kind of treatment is this?

Answer 26

Hospice- a good death. No longer pursuing curative treatments

Question 27

The Right to Die and the Right to Refuse Treatment: How should nurses be with a patient refusing treatment? What should the nurse consider?

Answer 27

Support the patient’s right to refuse treatment. Consider the perceived burden of illness.

Question 28

The Right to Die and the Right to Refuse Treatment: What does the nurse have to ensure about the decision to die/refuse treatment by the patient?

Answer 28

Ensure the decision is truly autonomous.

Question 29

The Right to Die and the Right to Refuse Treatment: Withholding and Withdrawing Life-Sustaining Treatment: What is an example?

Answer 29

Exemplar case: Terri Schiavo Substituted judgment standard

Question 30

Rule of Double Effect: Conditions in which an act causing good and evil is permitted means?

Answer 30

1. Act is not in itself wrong 2. Nurse intends good and not the harm 3. The situation is proportionately grave, and the nurse takes care to mitigate harm

Question 31

Rule of Double Effect: Nursing Considerations: What should nurses be aware of? What should nurses be relieving? How should nurses evaluate cases?

Answer 31

Be aware of the potential for hastening death. Relieve pain and other symptoms. Evaluate each circumstance individually.

Question 32

Terminal Sedation: When is it used?

Answer 32

Used only in the last stages of life

Question 33

Terminal Sedation: What does it require?

Answer 33

Requires understanding of ethical implications

Question 34

Terminal Sedation: How is it done?

Answer 34

Sedation is administered to render a person unconscious as life-supporting technologies are withheld

Question 35

Euthanasia: What is it?

Answer 35

the act of assisting people with their death in order to end their suffering, but without the backing of a controlling legal authority

Question 36

Euthanasia: Can be ____or _____.

Answer 36

Can be autonomous or paternalistic

Question 37

Euthanasia: What are the types?

Answer 37

Active euthanasia Passive euthanasia Voluntary euthanasia Nonvoluntary euthanasia Involuntary euthanasia

Question 38

Active euthanasia

Answer 38

Intentional act of causing immediate death

Question 39

Passive euthanasia

Answer 39

Intentional withholding of life-sustaining treatments

Question 40

Voluntary euthanasia

Answer 40

Patient authorization of euthanasia

Question 41

Nonvoluntary euthanasia

Answer 41

Occurs with persons unable to consent

Question 42

Involuntary euthanasia

Answer 42

Occurs when consent is possible but not sought

Question 43

Physician-Assisted Death aka?

Answer 43

AKA Medically-aided death-

Question 44

Physician-Assisted Death AKA Medically-aided death- What is required for it?

Answer 44

Individuals must have a terminal illness + a prognosis of six months or less to live.

Question 45

Physician-Assisted Death: What cannot occur?

Answer 45

Physicians cannot be prosecuted for prescribing medications to hasten death.

Question 46

Physician-Assisted Death: States that it is allowed?

Answer 46

Allowable by law in: Oregon, Washington, Montana, Vermont, California, Colorado, Washington D.C., Hawai’i, New Jersey, Maine, New Mexico

Question 47

Which state has the death with dignity act?

Answer 47

Death with Dignity Act in Oregon

Question 48

Oregon Nurses' Association has guidelines for nurses who care for patients choosing physician-assisted death Nurses may NOT

Answer 48

Administer the medication, the patient must do so themselves Breach confidentiality- Duty to Disclose waived Make judgmental statements about the patient Refuse to render care

Question 49

Types of Suicide

Answer 49

Physician-Assisted: Rational Suicide Irrational Suicide

Question 50

Types of Suicide: Physician-Assisted: What is it?

Answer 50

Physician-Assisted: Taking own life with a lethal dose of physician-ordered medication

Question 51

Types of Suicide: Physician-Assisted: How is it being viewed?

Answer 51

Increasing acceptance

Question 52

Physician-Assisted: What three conditions must be met:

Answer 52

Know that person intends to end life Make means available to the person Person must then end life

Question 53

Types of Suicide: Rational Suicide: How is it categorized?

Answer 53

Categorized as voluntary, active euthanasia

Question 54

Types of Suicide: Rational Suicide: Someone contemplating this:

Answer 54

Has a realistic assessment of circumstances Is free from severe emotional distress Has motivation understandable to most uninvolved people

Question 55

Types of Suicide: Irrational Suicide

Answer 55

Irrational thinking accompanying psychiatric disorder and that accompanying suicidal ideation and between state and trait cognitive dysfunctions

Question 56

Care for Dying Patients: Three major themes (Maeve, 1998)

Answer 56

Tempering involvement Doing the right/good thing Cleaning up

Question 57

Care for Dying Patients: What must be done?

Answer 57

Be honest with patients. Inform on advance directives and treatment. Relate to patients’ fear of death. Alleviate pain and suffering.