class 4

Question 1

What are the key elements of informed consent according to the Health Care Consent Act of Ontario?

Answer 1

The key elements of informed consent according to the Health Care Consent Act of Ontario include:

Competency: The individual must be competent to give consent.
Specificity: Consent is procedure-specific. Giving consent for one procedure doesn’t imply consent for other unforeseen treatments.
Information: The practitioner must inform the individual about the procedure.
Question and Answer: There should be an opportunity for the patient to ask questions and get them answered.
Voluntariness: Consent must be voluntary and not obtained through misrepresentation or fraud.

Question 2

Can you explain what “voluntary” consent means in the context of informed consent?

Answer 2

Informed consent is considered voluntary when it is given without coercion, pressure, or manipulation and aligns with the patient’s free will.

Question 3

What does it mean for a person to be considered “incompetent” in the context of giving informed consent?

Answer 3

Being “incompetent” means that a person cannot understand the information provided to them and cannot repeat it in their own words. Not speaking English or not having a good command of the English language does not necessarily make someone incompetent. In such cases, a translator is required by law to ensure understanding.

Question 4

When is a translator required for obtaining informed consent in cases involving language barriers?

Answer 4

A translator is required by law when a patient cannot understand the information being provided and express it in their own words due to language limitations.

Question 5

What is advanced care planning, and what does it result in?

Answer 5

Advanced care planning is a process where individuals indicate their treatment goals and preferences for end-of-life care. This process can result in an advanced care plan, also known as a living will.

Question 6

Why is it essential for informed consent to be procedure-specific? Provide an example.

Answer 6

Procedure-specific consent ensures that patients understand and consent to the exact treatment they will receive. For example, consent for a heart stress test is not the same as consent for treating a seizure during the test.

Question 7

What role does the question and answer period play in the informed consent process?

Answer 7

The question and answer period allows patients to seek clarifications, ensuring they have a thorough understanding of the proposed treatment, potential risks, and alternatives

Question 8

Explain why informed consent must be given freely, and why is it vital to prevent consent obtained through misrepresentation or fraud?

Answer 8

Informed consent must be voluntary to ensure that patients are not coerced or misled into making decisions against their will, safeguarding their autonomy and rights.

Question 9

What is an advanced directive, and why is it important?

Answer 9

An advanced directive is a statement made by a competent person about the desired treatment in case they become unable to make or communicate those decisions in the future. It is important because it allows individuals to have control over their medical decisions when they are no longer able to make them, ensuring that their wishes are respected.

Question 10

Can you explain what a living will is and how it relates to advanced directives?

Answer 10

A living will is a type of advanced directive. It enables an individual to specify their preferences regarding life-sustaining treatment, particularly when it comes to refusing such treatment. It is part of advanced care planning and helps ensure that an individual’s end-of-life treatment choices are respected.

Question 11

What are the 5 steps to Advance Care Planning?

Answer 11

TLDTR
Think - what are ur values, beliefs, and understanding about your care and your medical procedures?
Learn - about different procedures and what they can and cant do
Decide - who will be your substitute decision maker. Someone who is wiling and able to speak for you if you cant speak for yourself
Talk - about your wishes with your substitute decision maker, maker loved ones and your doctors
Record - your wishes. It’s a good idea to write down your make a recording of you wishes.

Question 12

Can you provide an example of a situation where a person might use a living will?

Answer 12

A living will might be used to specify a patient’s desire not to be put on life support if they enter a persistent vegetative state.

Question 13

What are the different cognitive states discussed in the notes, and how do they differ from one another?

Answer 13

The cognitive states discussed include Coma, Vegetative State, Persistent Vegetative State, Permanent Vegetative State, Minimally Conscious State (MCS), and Locked-In Syndrome.

• Coma is a state of profound unconsciousness and unresponsiveness, and people can recover, progress to a vegetative state, or die.
• Vegetative State involves no detectable awareness, with eyes potentially open, and it is considered persistent after 4 weeks.And permanent after 3 months (cardiac arrest) to 12 months (brain injury)
• MCS exhibits intermittent awareness of self and environment, with some limited responses to stimuli.
• Locked-In Syndrome results in paralysis of muscles, except eye muscles, where the patient is conscious and aware but cannot move or communicate verbally.

Question 14

What is the primary difference between a Coma and a Vegetative State, and what are the key risks associated with a Coma?

Answer 14

A significant difference between a Coma and a Vegetative State is that a person in a coma requires hospital care, and a deep coma may involve some loss of lower brain and pawns function. People can recover from a coma, even after a month, although it carries a high risk for infections, bedsores, pneumonia, and other factors that may lead to death.

Question 15

What factors determine whether a Vegetative State is considered “persistent” or “permanent,” and what kind of home support might individuals in such states need?

Answer 15

A Vegetative State is considered persistent if it lasts for 4 weeks, and it is considered permanent if it persists for 3 months (in cases of cardiac arrest or drowning) or 12 months (in cases of traumatic brain injury). Individuals in these states may go home if they are stable but typically require home support, including ventilation for breathing and home feedings.

Question 16

Can you describe the key differences between Minimally Conscious State (MCS) and the Vegetative State, and what are the three groups into which people with MCS can be categorized based on their condition or injury?

Answer 16

MCS patients exhibit some cognitive behaviors and limited awareness of self and the environment. While both MCS and Vegetative State individuals are severely impaired, MCS individuals may show some response to emotional content, stimuli, gestures, eye movement, and direct response to questions.

People with MCS can be categorized into three groups based on the nature of their condition or injury: developmental or congenital brain injuries, acquired traumatic or non-traumatic brain injuries, and progressive degenerative diseases of the central nervous system.

Question 17

What aspects of the Terri Schiavo case are highlighted in the notes, including the legal struggles and the role of advance directives?

Answer 17

The Terri Schiavo case involved a cardiac arrest that led to a persistent vegetative state. Terri did not have an advance care directive. There was an eight-year court struggle between her husband, who wanted to remove her feeding tube, and her parents, who claimed she was in a minimally conscious state. The case highlighted the importance of legal advance directives and discussions regarding vegetative state, coma, and minimally conscious state.

Question 18

What modern myths about life and death were exposed through the Terri Schiavo case?

Answer 18

The Terri Schiavo case exposed three modern myths about life and death:
1. The belief that death with dignity is attainable as long as people make living wills.
2. The misconception that only patients themselves are permitted to take the quality of life into account when making life-sustaining decisions.
3. The idea that medical innovations and miracle cures can promise the extension of life indefinitely.

Question 19

Is a Persistent Vegetative State (PVS) always permanent, or have there been cases challenging its permanence?

Answer 19

PVS is typically considered permanent, but there have been cases that challenge its permanence. For example, stimulation of the vagus nerve allowed a patient who had been in a persistent vegetative state for 15 years to exhibit signs of consciousness, including tracking objects with his eyes and responding to simple requests. This case demonstrated that the permanence of PVS might not be absolute.

Question 20

Why might the concept of the “double effect” be relevant in end-of-life decisions? Provide an example.

Answer 20

The “double effect” principle is relevant because it addresses situations where an action may have both positive and negative consequences. For example, administering pain relief that may unintentionally hasten death is ethically permissible if the primary intention is to relieve pain.

Question 21

What ethical considerations should be taken into account when discussing euthanasia as an end-of-life option?

Answer 21

Ethical considerations related to euthanasia include the patient’s autonomy, the principle of beneficence, the avoidance of harm, and the overall impact on the patient’s well-being.

Question 22

Can you provide an example of when euthanasia might be considered ethically permissible?

Answer 22

Euthanasia might be considered ethically permissible in cases where a terminally ill patient is suffering immensely, despite all available medical interventions, and they have made a well-informed, voluntary request to end their life.

Question 23

How does “medical aid and dying” empower patients in making end-of-life decisions?

Answer 23

Medical aid and dying empowers patients by allowing them to have control over the timing and manner of their death when faced with unbearable suffering due to a terminal condition

Question 24

How does medical aid and dying differ from euthanasia in terms of the patient’s role in the process?

Answer 24

In medical aid and dying, the patient plays a more active role by making the decision and taking the prescribed medication, while in euthanasia, a physician administers the lethal medication.

Question 25

Can you provide an example of a jurisdiction where medical aid and dying is legally allowed?

Answer 25

Canada is an example of a jurisdiction where medical aid in dying is legally permitted for eligible patients who meet specific criteria.

Question 26

What are the primary reasons why people request a prescription for lethal medication under the Oregon Death with Dignity Act (DWDA)?

Answer 26

People request a prescription for lethal medication under the Oregon DWDA for several reasons, including concerns about the **loss of autonomy, decreasing ability to participate in enjoyable activities, and the loss of dignity** These factors are often associated with the experience of a terminal illness.

Question 27

Can you explain the key judicial decisions in Canada related to physician-assisted suicide, and how did they impact the law in the country?

Answer 27

In Canada, key judicial decisions related to physician-assisted suicide include Gloria Taylor’s challenge to the law in 2011, which led to a BC court ruling in 2012 that found provisions against assisted dying violated the rights of the gravely ill. In June 2014, Bill 52 legalized “medical aid in dying” in Quebec, and in June 2016, the Supreme Court of Canada passed Bill C-14, allowing Canadians with terminal illnesses to choose physician-assisted death. However, Bill C-14 had specific issues related to the foreseeability of death and competency to request, which were later addressed by Bill C-7 in March 2021.

Question 28

How has the legality of physician-assisted death evolved over the years, and which states in the U.S. currently permit it?

Answer 28

Initially, the U.S. Supreme Court left it to individual states to craft their policies regarding physician-assisted death, and it was up to each state to decide whether to prohibit or permit it. As of the provided information, physician-assisted death, known as Medical Aid in Dying (MAiD), is legal in 11 states: California, Colorado, District of Columbia, Hawaii, Montana, Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington

Question 29

What are the eligibility criteria for Medical Aid in Dying (MAiD) under Bill C-7 in Canada? What are two diffrences compared to Bill C.14?

Answer 29

Under Bill C-7, to be eligible for MAiD in Canada, an individual must be 18 years or older, eligible for government-funded health insurance, have made a voluntary request Bill C.14 is having a “grievous and irremediable medical condition” in the criteria. This condition includes having a serious illness, disease, or disability(to be appealed (march 17,2024) that is in an advanced state of decline and causes unbearable physical or mental suffering that cannot be relieved under acceptable conditions. The key difference from Bill C-14 is the expansion of eligibility criteria. Bill C-7 allows for waiver of final consent for those whose natural death is reasonably foreseeable.

Question 30

What two points does the canadian law requires consent for MAiD be provided?Can you explain the concept of “final consent” and the waiver of final consent in the context of MAiD in Canada?

Answer 30

In Canada, the law requires that consent for MAiD is provided at two time points: **at the time of the written request** and **immediately before MAiD is conducted** (referred to as “final consent”). However, there is an option for a waiver of final consent for individuals whose natural death is reasonably foreseeable. This waiver allows patients to proceed with MAiD even if they lose the capacity to consent at the time of the procedure. It is based on a signed and dated agreement with the medical practitioner. This waiver is an improvement introduced in Bill C-7 and was named after Audrey Parker, who accessed MAiD earlier than she wanted to due to the previous consent requirements.

Question 31

What is the purpose of the 90-day waiting period for MAiD for individuals whose death is not reasonably foreseeable, and can you provide examples of such cases?

Answer 31

The 90-day waiting period for MAiD is meant to explore “other treatments and services that could relieve the person’s suffering” instead of proceeding with MAiD. This waiting period applies to cases where natural death is not reasonably foreseeable. Examples of such cases include incurable cancer, dementia, spinal cord injury, or individuals on feeding tubes. In these cases, the person may be suffering, but their death is not considered reasonably foreseeable.

Question 32

What are some of the controversies and debates surrounding Bill C-7 and its changes, as mentioned by disability activists?

Answer 32

: Disability activists have raised concerns about Bill C-7, particularly the changes coming in March 2024. Some of the points of contention include: * Lack of sufficient resources for those in poverty compared to the ease of obtaining MAiD. * Failure to care for the most vulnerable in society versus improving the lives of people living with disabilities. * Fears of people being forced into euthanasia by their circumstances, and concerns that healthcare providers might encourage euthanasia instead of providing social services. * The belief that it may be cheaper for the government to have people die by MAiD than to provide care through social services and funding.

Question 33

In 1997, how did the U.S. Supreme Court’s decision in the Nancy Cruzan case shape the legal landscape regarding the right to refuse treatment and the right to hasten death?

Answer 33

The U.S. Supreme Court upheld the Nancy Cruzan case, emphasizing that the right to refuse treatment is based on the right to maintain bodily integrity, not necessarily to hasten death. The focus was on honoring the patient’s wishes when treatment is withheld or withdrawn

Question 34

What are the two types of MAiD allowed in Canada under Bill C-7, and when is the option of a waiver of final consent available, and who is it named after?

Answer 34

In Canada, two types of MAiD are allowed: either a physician or nurse practitioner can directly administer a substance causing death, or they can prescribe a substance for the patient to self-administer. The option of a waiver of final consent is available only for patients whose natural death is reasonably foreseeable. It is named after Audrey Parker, who faced the issue of loss of capacity before a planned MAiD procedure.

Question 35

What is the distinction between allowing a person to die and assisting someone in dying, and what does “assisted death” or “assisted suicide” refer to?

Answer 35

Allowing a person to die refers to withholding or withdrawing treatment, while assisting someone in dying involves providing a terminally ill person with the means to end their life. “Assisted death” or “assisted suicide” refers to providing someone with the means to kill themselves.