End of Life Ethics Flashcards Preview

Year 2: Medical Ethics & Law > End of Life Ethics > Flashcards

Flashcards in End of Life Ethics Deck (28)
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1
Q

How is the way we are dying changing?

A
  • Less common to die quickly
  • Rise in co-morbidities and frailty
2
Q

How does the concept of a ‘good death’ change?

A
  • Faith cultures (rites/rituals)
  • Individualist society and promotion of personal autonomy
  • Multicultural society, multiple beliefs
  • Informed choice, anticipatory care planning
3
Q

What makes a good death and what makes a bad death?

A
4
Q

Studies have revealed the preferred place of death is where?

A

Home, then a hospice

5
Q

Where do most people die?

A

Hospital

6
Q

What is quality of life enhanced by as we age?

A
  • Caring attitude of staff
  • Family visits
  • Physical environment
  • Maintaining control
  • Feeling safe/not alone
  • Art sessions
  • Smoking
7
Q

What is quality of life diminished by as we age?

A
  • Lost independence
  • Lost activities
  • Pain/fear of pain
  • Feeling a burden
8
Q

What are the ethics to consider when a patient requests their prognosis?

A
  • Many patients do want to know there prognosis, others will not
    • Non-malfeasance
    • Beneficence
  • Often families will want to know more than patients
    • Respect autonomy
    • Confidentiality
  • Give the ‘gist’ rather than statistics
9
Q

Example, an 84 year old has pancreatic cancer and her daughter requests that you do not tell her as nothing can be done, what ethics must be considered?

A
  • Capacity
  • Benefit/best interest
  • Autonomy
  • What if the daughter has power of attorney
10
Q

What is collusion?

A

Refers to a secret agreement made between clinicians and family members to hide the diagnosis from the patient:

  • Possible reasons for collusion needs to be established
  • Establish patients level of awareness by asking relevant and direct questions
  • Process helps break barriers between the patient and relatives
11
Q

What are some reasons families may wish to collude?

A
  • Disclosure causes the patient to lose hope
  • Disclosure leads to depression
  • Disclosure hastens the progression of the illness and death
  • Disclosure increases the risk of patient suicide
  • Disclosure may cause psychological pain for the patient
  • Family members themselves may not be aware of the nature and severity of the illness
  • Family members may be in denial
  • Family members may be in conflict
12
Q

Why does collusion go against the best clinical practice?

A
  • Patient factors
    • At odds with patient autonomy
    • Revealing diagnosis to relatives before patient breaches confidentiality
    • Patients cannot give informed consent if not aware of underlying illness
    • Patient not able to complete unfinished business before death
  • Family factor
    • Family members have to bear burden of being untruthful
    • Barrier in communication at time when patient needs it most
    • Families have no guidance on making treatment decisions
  • Clinician factors
    • Breakdown of clinician-patient relationship and loss of trust
    • May face treatment non-compliance from patients
13
Q

What is a DNACPR form?

A

Not a legal document, but a record of decision, need document rationale in notes if not discussed with patient

Provide guidance for clinicians who do not know the patient

14
Q

What is the guidance for using a DNACPR form?

A
  • Patients must be aware of DNACPR form
  • If the patient lacks capacity must inform those close to the patient without delay
  • When there is clinical certainty DNACPR will remain in place, does not need to be reviewed
15
Q

What types of cardiac arrests are shockable?

A

Only VF and VT

16
Q

What is an example of withdrawal of treatment?

A

Stopping non-invasive ventilation

17
Q

Can patients refuse treatment?

A

It is the patients legal and ethical right to decide to refuse treatment:

  • If they have capacity the decision must be respected. Even if this may lead to death
  • Continuing unwanted treatment is battery and is a criminal offence
18
Q

What is continuing unwanted treatment on a patient considered to be?

A

Battery and is a criminal offence

19
Q

What are important things to consider when withdrawing treatment?

A
  • Communication is key
  • Planning and preparation
  • When a treatment is started patients should understand it can be withdrawn if they no longer want it
  • Symptoms should be anticipated and managed effectively
20
Q

What ethics must be considered when withdrawing treatment?

A
  • Capacity
  • Best interests
  • Justice
21
Q

What are the ethics of withdrawing treatment for a patient with no capacity?

A
  • Duty to treat in patients best interests
  • No obligation to prolong patients life irrespective of the quality of life or patients own views unless it is in the patients best interest
  • In some cases comes a point when continuing treatment ceases to be in patients best interest and not able to provide a quality of life the patient would find acceptable
    • In such a case the presumption in favour of prolonging life will be rebutted
22
Q

When is letting a patient die (not admitting them to hospital) acceptable?

A
  • Medical technology is useless
  • Patient validly refuse a medical technology
    • Ideally consensus patient, their family and other clinical staff
23
Q

What may happen if you let a patient die (do not admit them to hospital) when the criteria to do so is not satisfied?

A

May be considered medical negligence

24
Q

What is euthanasia?

A

Act of deliberately ending a person’s life to relieve suffering

25
Q

What is assisted suicide?

A

Act of deliberately assisting or encouraging another person to kill themselves

26
Q

What does physician assisted suicide involve?

A

Prescribing lethal drugs intended explicitly to end a life

27
Q

What are some arguement for euthanasia?

A
  • Suicide is legal. Those who are so disabled they cannot take their own life are disadvantaged.
  • Withdrawing and withholding life-prolonging treatment is widely accepted and practised.
  • The suffering associated with some diseases outweighs the benefits of continuing to live.
  • Respect for patient autonomy.
28
Q

What are some arguements against euthanasia?

A
  • Good palliative care obviates the need for PAS.
  • Discourages palliative care research.
  • Vulnerable patients are at risk – coercion, feeling like a burden, free up medical resources.
  • Slippery slope - may lead to involuntary euthanasia for people deemed ‘undesirable’.
  • Affects other people’s rights, not just the patient.
  • Contrary to the aims of medicine – promotion of health and life. Patients may lose trust.