END-OF-LIFE DECISION-MAKING (PART 1 Flashcards
Limitation to duty of health care professionals
Since life has a natural end, the duty of healthcare professionals does not extend to sustaining life artificially for many years in relation to patients for whom there is little hope of recovery.
What is the duty of health care professionals in this aspect?
The duty of the health care professional is to alleviate the suffering of a terminally ill patient by allowing the natural process of death to follow its course.
Two ways to describe Any medical intervention where the health care professional’s primary intention is to end the patient’s life
- contrary to the ethics of healthcare AND * unlawful.
What does futile generally refer to?
refers to treatment that is ineffectual, inadequate, and serves no useful purpose (non-beneficial/useless) in curing the patient or alleviating the suffering.
How does The World Medical Association (WMA) Medical Ethics Manual describe treatment thats medically futile?
Where the treatment where:
* ‘offers no reasonable hope of recovery or improvement or
* the patient is permanently unable to experience any benefit’.
What does the The WMA Medical Ethics Manual state on how the utility (usefulness) and benefit of a treatment can be determined?
the utility (usefulness) and benefit of a treatment can only be determined with reference to the patient’s subjective judgment about [their] overall wellbeing’.
What does the The WMAMedical Ethics Manual statesstate about the patient;s involement?
a patient should generally ‘be involved in determining futility in [their] case’, except where the involvement of the patient in the decision-making regarding futility would not be in the patient’s best interests.
Why is the The concept of ‘futile medical treatment’ contreversial?
- it impacts on the ethical principle of autonomy and the patient’s right to access to health care services,
- there is variability in how futility is perceived by the healthcare profession.
WMA Medical Ethics Manual on involvement of patients or their proxies
WMA Medical Ethics Manual states that patients or their proxies should be involved in discussions about withdrawal of treatment on grounds of futility.
def of ‘proxy’ in the healthcare setting
is a representative of a patient (such as a relative, lawyer, or friend), i.e. a person acting on behalf of the patient and in accordance with the patient’s wishes (where this has been previously expressed) and/or the patient’s best interests.
a person who: * has the authority to make health care decisions for the patient in circumstances where the patient is unable to communicate effectively (for example, an infant or a person who is mentally ill or who has learning disabilities, a person in a coma, etc.)
What should doctors discuss with patients or their proxies When deciding whether to terminate (withdraw) or refuse (withhold) treatment,
the limits of the patient’s autonomy (e.g. patients may not request a doctor to do something unethical or illegal
When deciding whether to terminate (withdraw) or refuse (withhold) treatment, doctors must discuss with the patient and/or their proxies the need to consider other ethical implications, such as:
- immediate detriment to the patient and risk of harm (which is contrary to the principle of non-maleficence), * ineffectiveness of treatment (which is contrary to the principle of beneficence and the patient’s best interests) and
WMA Medical Ethics Manual on what the doctor is not obligated to do
a doctor has ‘no obligation to offer a patient futile or non-beneficial treatment’.
What is a doctor entitled to do?
Adoctor is entitled to refuse to provide treatment if the treatment is unlikely to be beneficial, even if it is not harmful.
forms of futility in the health care setting
- quantitative,
- qualitative or
- both quantitative and qualitative.
What happes where Where the proposed treatment offers no reasonable hope of recovery or improvement or because the patient is permanently unable to experience any benefit
a doctor may prescribe a placebo if it improves a patient’s quality of life, since such treatment plays a palliative care role, which differs from futile treatment.
What is palliative care?
Benefits of palliative care
