End of Life

Question 1

Describe the double effect and provide example*

Answer 1

Justifies the provision of appropriate pain relief, even if it may hasten death because:
- the good intention is to eliminate pain
- a subsequent effect of that good intention may or may not hasten death

Ex. patient on morphine drip to keep them sedated but it was causing their respiratory rate to be flattened, causing hypoxia, and leading to organ failure/death

Question 2

What are the two general criteria to declare death?*

Answer 2

1. Brain death is cessation of all brain function
2. Must be irreversible

Question 3

What are two additional conditions that people suggest should be included in the definition of death?*

Answer 3

1. Anencephalic neonates
2. Patients in a persistent vegetative state

Question 4

What are the 4 goals of palliation?*

Answer 4

1. prolonging life
2. promoting a quality dying process and a dignified death
3. controlling pain
4. hastening the end of life

Question 5

What is medical futility? Who determines it?*

Answer 5

Situations in which interventions are judged to have no medical benefit or in which the chance for success is low

Historically it was physicians, but now it is a collaborative effort with family, nurses, and other team members

Question 6

What are the 9 MAID requirements in AB?*

Answer 6

1. older than 18
2. serious, incurable disease or disability
3. irreversible decline in capability
4. physical or psychological suffering is intolerable and cannot be relieved under conditions the client considers acceptable
5. natural death is reasonably foreseeable
6. client must be capable of making their own decisions
7. demonstrate voluntary request for MAID
8. provide informed consent
9. two clinicians independently assess criteria

Question 7

What are four issues that limit the number of organ donors?*

Answer 7

1. lack of declared donors
2. technology advances prolong life of potential donors
3. timeline for harvesting/transporting organs
4. obtaining consent

Question 8

List 5 strategies to increase organ donation*

Answer 8

1. recorded consideration - staff must document and request of all suitable patients
2. required request - approach all patients on admission
3. presumed consent - patients must opt out if they do not wish to donate
4. market strategies - offer lump-sum payment or funeral expenses
5. public education