End of Life Ethics Flashcards
(37 cards)
What are the ethical issues facing nurses providing end of life care?
- Provision of “futile” care (Acharnement thérapeutique)
- Poor DaNR / LOC discussion
- Conflicts over goals of care
What are conditions for a good death?
- Relief from physical pain and other symptoms
- Effective communication and relationships with healthcare providers
- Performance of cultural, religious or other spiritual beliefs
- Relief from emotional distress or other forms of psychological suffering
- Autonomy with regards to treatment and decision making
- Dying in the preferred place
- Life not being prolonged unnecessarily
- Awareness of the deep significance of what is happening
- Emotional support from family and friends
- Not being a burden on anyone
- The right to terminate one’s life
What was the discussion prior to end-of-life care advances?
The ethics of patients/families asking for life support to be WITHDRAWN and healthcare professionals being uncomfortable with it.
How has the discussion shifted around end-of-life care?
The ethics of patients/families asking for life support treatment to be CONTINUED and healthcare professionals being uncomfortable with it.
What are ethical issues within end-of-life care?
- How should we balance patient autonomy VS duty to non-maleficence, beneficence and professional integrity?
- How should we respond when there are conflicts over goals of care at the end of life?
- WHO gets to decide what type of life is worth living?
If patients do not have the ability to consent to end-of-life care, who can consent for them?
Surrogate decision maker designated by the patient or acting by default according to law.
What is the order of surrogate decision makers in Quebec?
- Mandatary, tutor or curator
- Spouse
- Close friend or relative
How should surrogate decision makers decide on the patients best course of action?
They should consider the patient’s prior expressed wishes. If unknown, based on the best interest standard.
What is the best interest standard?
- Care is beneficial
- Advisable under the circumstances
- Burdens should not outweigh benefits
What are the multiple meanings of futility?
- Futility as “will not work”
- Futility as “not worth doing”
How to describe futility as “will not work”?
- Objective standard
- Rare
- Treatment will not be physiologically effective in achieving its goal (dialysis will not work due to hypotension).
How to describe futility as “not worth doing”?
- More subjective
- Involves value judgments
- More common
- What counts as benefit or success when we talk about treatment?
(EX: - Treating team: beneficial = return to baseline.
- Family: beneficial = survival)
What to do when disagreeing about the right thing to do in end-of-life care?
Rely on ethically sound and fair process to arrive at a decision.
Applied ethics: Process in the event of a disagreement
- CONSENSUS OPINION from medical team about what should and should not be offered based on best interest standards.
- Offer psychosocial support to family.
- Ask for/offer second opinion
- Meet on a regular basis
- Can consider limited trial of therapy if appropriate
- Ethics consult
- May offer transfer to another institution
Unhelpful strategies
- Delaying conversation about death or dying
- Asking questions like: “Do you want us to do everything?” or saying “There is nothing more we can do”
- Lacking time and resources to provide proper care
- Valuing curative care over quality of life and supporting the dying
- Seeing treatment and palliative care as mutually exclusive
- Viewing LOC discussions as one-off discussion
- Living in a “death denying” society.
Helpful strategies for helping patients
- Practice, self-reflection
- Be present, listen to patients, be curious
- Informed consent is a PROCESS that takes time
- Goals of care discussion should focus on GOALS
- Quality end of life care is just as important as curative care
- Facilitate partnerships with shared power and shared decision making
- Support caregivers and decision makers
- Practice self-care
Are patients/family able to consent to goals of care and treatment?
Yes, but this right is not absolute.
They can’t demand treatment that is outside the standard of care for which there is no anticipated benefit.
What are guiding principles to balance autonomy VS non-maleficence?
- Strong medical consensus that aggressive interventions will not work and should not be offered
- Offering interventions in which burdens clearly outweigh benefits violate standards of professional integrity and non-maleficence.
- Continue to support the family.
What is the definition of palliative care?
Palliative care is an approach that improves the quality of life of patients and family who are facing problems associated with life-threatening illnesses.
Palliative care is explicitly recognized under the human right to health.
It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems.
Promotes opportunities for meaningful and valuable experiences, personal and spiritual growth, and self actualization.
What articles are included within the “Act respecting end of life care”?
- Every person whose condition requires it has the right to receive end-of-life care.
- Every institution must offer end-of-life care
What is the intention of palliative care?
It is not curative, but to help the patient feel as well as they can without seeking to prolong life, nor to hasten death.
What is continuous palliative sedation?
The use of sedative medication to relieve suffering by keeping the person unconscious (asleep) until death.
The intention is to relieve suffering, not hasten death.
What is the indication of continuous palliative sedation?
For a person at the end of life with a short prognosis where it may be impossible to achieve adequate relief of suffering and pain despite high quality palliative care.
What is the doctrine of double effect?
Performing an act that brings about a good consequence may be morally right even though the good consequence can only be achieved at the risk of a harmful side effect.
