End of life care

Question 1

What is the difference between healing and curing?

Answer 1

Curing = getting rid of disease

Healing= ready to grow and change

Question 2

What are the four paradigms in the U.S. today?

Answer 2

1. Death is a natural part of life
2. The medicalization of dying
3. Palliative medicine/hospice
4. Death on demand (physician assisted suicide)

Question 3

What percent of conscious patients had moderate to severe pain at least 50% of the time before death?

Answer 3

50%

Question 4

What percent of patients say they did not wish to have CPR? What percent of prim physicians were unaware of this?

Answer 4

31%

over half

Question 5

Nearly half of DNR orderes were written within what time frame prior to the patient’s death?

Answer 5

2 days

Question 6

What percent of patients spent at least 10 days in ICU?

Answer 6

40%

Question 7

What are the four outcomes noted in the support study?

Answer 7

1. Poor symptom management
2. Inconsistent with pt preferences and values
3. Problematic communication and decision making
4. Life-prolonging intensive treatments vs palliative hospice care

Question 8

What are the eight goals of medicine?

Answer 8

1. Promotion of health
2. maintenance/improvement of quality of life be relief of symptoms, pain and suffering
3. Cure of disease
4. Prevention of untimely death
5. Improvement of function status/maintenance of compromised status
6. Education/counseling re” condition/prognosis
7. Avoidance of harm to patient in course of care
8. Providing relief and support near the time of death

Question 9

What determines technology’s moral valance?

Answer 9

How it is used

Question 10

What are the five evaluating modalities of treatment

Answer 10

1. Risks
2. Benefits
3. Burdens
4. Probability
5. Harm

Question 11

What is the main difference between withdrawing an withholding?

Answer 11

Emotionally

Question 12

Good ethic always begin with what?

Answer 12

Good information

Question 13

What is the biggest question to ask in palliative medicine?

Answer 13

What is the goal

Question 14

Patients with dementia should be fed how (tube feeding or oral assistance)?

Answer 14

Oral assistance

Question 15

What are the three way patients are averse to food?

Answer 15

1. Clench teeth
2. Stop feeding by gasping offered hand
3. Saying No

Question 16

What are the steps of the goals of care conversation?

Answer 16

1. Review the clinical situation
2. Assess the decision maker’s understanding
3. Establish the patient’s Goals of care
4. Present options to manage clinical issues
5. Weigh risks and benefits with valus and preference
6. Measure effects the decision has on family and loved ones
7. Offer additional sources of decisional support
8. Provide ongoing support and recognize the need to revisit the decision

Question 17

What are the four types of euthanasia?

Answer 17

Voluntary
Involuntary (saying no)
Nonvoluntary (made no request)
Passive euthanasia (erroneous term)

Question 18

What are the principles of double effect?

Answer 18

Naure of the act was good

Agent’s intentions (agent must intend only good)

Distinction between means and effects (bad effecs must not be a means to the good effect)

Proportionality between the good effect and the bad effect (good effect must outweigh the bad)

Question 19

What is the definition of medical futility?

Answer 19

Unnacceptable liklihood of achieving a therapeutic benefit for the patient

Question 20

What are the three names of the legal cases for right to die?

Answer 20

Quinlan
Cruzan
Schiavo

Question 21

What are the four components of the circle of decision makers?

Answer 21

Self
Direction
Best interest
Court

Question 22

What is the most unacceptable phrase in end of life care?

Answer 22

“There’s nothing more we can do”