Ethics Final Flashcards

Question

True or false: PVS is defined as whole brain death

Answer 1

-false -bc the brainstem is still working

Answer 2

Baby Doe 1

Answer 3

-baby doe 1 -April 9, 1982 in Bloomington, IN -down syndrome with tracheoespohseal fistula -the family was told that the baby had 50% chance of surviving surgical repair -not a very good prognosis for future function -family decides not to treat -family physician and pediatrician disagree -the case was filed as neglect under the Indiana child in need services statute -the lower courts sided with the parents and the Indiana supreme court doesn't want anything to do with it -infant died before supreme court case C. Evverett Coop was surgeon that had fixed this problem before and he said the baby had greater chance than 50% he said the choice was based on discrimination and Reagan were incensed

Answer 4

-discrimination due to the fear of future disability -Reagan Administration rules under See 504 of Rehabilitation Act 1973 -Sinage in NICU's Hotline # and baby does squads (regulations) 'discriminatory failure to feed and care for handicapped infants in the facility is prohibited by federal law' Janurary 1984

Answer 5

-Keri- Lynn was born on October 11, 1983 with Spina Bifida, hydrocephalus, kidney damage and microcephaly (small head) -stony brook medical center -Lawrence Washburn, Vermont, files suit -1986 US Supreme Court: Bowmen V AHA struck down first rules (privacy and parental autonomy using 'best interest' and autonomy of states) -On June 1, 1985 Baby Doe Amendment is law and it is still in effect -1988 Revision of Child Abuse Prevention and treatment Act (CAPTA)

Answer 6

-October 13, 1992, Stephanie Keene born at Fairfax Hospital, Washington, D.C. -Anencephaly (only had midbrain and was never going to wake up) (baby also has resp problems) -Mother refused abortion on religious grounds. -Mother insisted everything must be done! -Tx to SNF at 6 weeks, off vent, Full Core. -Multiple re-admits for respiratory distress and apnea. -Tracheostomy at 3rd admission, 6 mos old. -Hospital must treat based on EMTALA (emergency medical treatment and active labor act) , Rehabilitation act 1973, ADA -Treatment of respiratory distress and apnea. Anencephaly not the issue. -Baby K died April 1995, 2.5 yrs of age.

Answer 7

-Rule used to justify withholding/withdrawal of artificial nutrition and hydration or any other LST. -Right to refuse care. Nonbeneficial or burdensome -Not “Double Effect.” -WLST is Not PAS or euthanasia (its allows choices to be made by the patient or family, that care is overly burdensome and futile)

Answer 8

-Autonomy -Relief of suffering

Answer 9

-Immoral killing of innocent people -Conflict of interest (physicians have to make ppl get better) -Slippery slope liberalization of practice

Answer 10

Psychological criterion: State of unconsciousness: body and mind are no longer an active functional unity. Biological criterion: State of widespread, non-function across organ systems. Cardiorespiratory and nervous system shutdown. Irreversible criterion: States become irreversible within minutes (5 -10) due to necrosis of key organ systems.

Answer 11

3 Baby Doe exceptions to giving treatment to newborn infant. (these still exist in the law) -Permanent unconsciousness -Futile treatment -Virtually futile treatment causing inhumane burdens

Answer 12

1. The object (action) must be morally good or at least neutral. 2. The bad effect must not be intended. 3. The good effect cannot be the result of the bad effect. 4. The good effect is proportional (outweighs or =) to the bad effect. 5. WLST does not need, RDE Refusal of care 6. WLST is NOT Euthanasia or PAS

Answer 13

-Condition where patients have some awareness which may be intermittent or limited. -Minimally conscious state, impaired but they can interact by moaning and doing purposeful, things, extremely disabled -Severe brain injury resulting in permanent unconsciousness with sleep-wake cycles. -PVS (Unresponsive wakefulness syndrome)

Answer 14

-Organ procurement -Criminal law, Tort law, Estate law, Life Insurance claims.

Answer 15

-Use of escalating doses of medications to relieve pain and suffering at end of life, even though it may hasten death. -Palliative (terminal) sedation -Explain how RDE justifies. -Action is control of pain(using reasonable doses to relive pain) -Intention is relief of suffering not killing the patient. Death of pt is not means of relieving pain. The relief of suffering is a good act even if medications hasten death.

Answer 16

1. Hysterectomy is morally neutral procedure when used for uterine cancer. 2. Intention is to treat cancer, not terminate pregnancy. 3. Death of fetus does not cure the uterine cancer. 4. Mother’s life saved is equal to unfortunate foreseen and permittable loss of fetus

Answer 17

-this is also known as PAS -this is when the physician writes the prescription and provides instructions for how the patient should prepare the medicine that will kill them -the patient has to do it themselves and cant be in the hospital while they take the meds -also known as Medical Assistance in Dying (MAID)

Answer 18

-physician participates in the intentional deliberate act to cause the immediate death of a person with a terminal incurable or painful disease by the medical administration of a lethal drug (active) -this is illegal in the U.S.

Answer 19

-in cases where it is nonbeneficial treatment is withdrawn or withheld -patients have the right to refuse treatment that they feel are nonbeneficial or burdensome -the catholic church does not support vitalism -there is a nonbeneficial care policy at each hospital

Answer 20

-withdraw or withhold life-sustaining treatments -if the patient has the ability to make decision, fully understands the consequences of their decision, and states they no longer want to a treatment -if the treatment no longer provides a benefit to the patient -patient has a valid advanced directive, that fits the situation or a surrogate/ proxy acting in good faith with consent of EC

Answer 21

-a 79 year old woman in failing health -she is admitted with abdominal carcinomatosis -has a pacemaker that has kept her alive for 29 yrs -has been in declining health for 3 years -wants to turn off her pacemaker -has DMC -RDE did no apply

Answer 22

-many clinicians feel that it is easier to withhold a treatment such as mechanical ventilation than to withdraw it -legally it is equally justifiable

Answer 23

-preserving physical life at all costs but rather asks us to embrace the virtues of fidelity (faithfulness to those in need), compassion (suffering with those who are suffering), and individual dignity

Answer 24

- Food and water -whether by mouth or by artificial means—are considered obligatory unless a person is imminently dying -However, the use of other technology may be optional depending on whether the means (treatments) are "ordinary" or "extraordinary.

Answer 25

-A person has a moral obligation to use ordinary or proportionate means of preserving his or her life -Proportionate means are those that in the judgment of the patient offer a reasonable benefit and do not entail an excessive burden or impose excessive expense on the family or the community

Answer 26

-A person may forgo extraordinary or disproportionate means of preserving life -Disproportionate means are those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive burden or impose excessive expense on the family or the community

Answer 27

-there is an obligation to provide patients with food and water -providing medically assisted nutrition and hydration for those who cannot take food orally -obligation extends to patients in chronic and presumably irreversible conditions (“PVS”) who can reasonably be expected to live indefinitely if given such care -Medically assisted nutrition and hydration become optional when they cannot reasonably be expected to prolong life or when they would be “excessively burdensome for the patient or would case significant physical discomfort, for example resulting from complications in the means employed.” -as a patient draws close to inevitable death from an underlying progressive and fatal condition, certain measures to provide nutrition and hydration may become excessively burdensome and therefore not obligatory in light of their very limited ability to prolong life or provide comfort.

Answer 28

The free and informed judgment made by a competent adult patient concerning the use or withdrawal of life sustaining procedures should always be respected and normally complied with, unless it is contrary to Catholic moral teaching

Answer 29

-Euthanasia is an action or omission that of itself or by intention causes death in order to alleviate suffering Catholic health care institutions may never condone or participate in euthanasia or assisted suicide in any way -Dying patients who request euthanasia should receive loving care, psychological and spiritual support, and appropriate remedies for pain and other symptoms so that they can live with dignity until the time of natural death

Answer 30

-“the quality that distinguishes a vital and functional being from a dead body.” -“an organismic state characterized by capacity for metabolism, growth, reaction to stimuli, and reproduction.” -“the sequence of physical and mental experiences that make up the existence of an individual.”

Answer 31

Restoring organ function as well as the mind-body relationship

Answer 32

Biologic: nervous, respiratory, and circulatory. Psychological: consciousness, ability to interact with surroundings and people

Answer 33

Not based on brain-death or DDR Utilitarian concept: -Nonmaleficence -Respect for autonomy -Respect for human dignity

Answer 34

-Confuses a prognosis with a diagnosis. -Based on permanent unconsciousness. -PVS? -Loss of functioning of the person “as a whole.” -Alan Shewmon -Societal consensus on definition of death.

Answer 35

brain injury leading to permanent loss of the capacity for consciousness, the ability to breathe spontaneously, and brainstem reflexes

Answer 36

-Profound coma – “eyes-closed unconsciousness” -Radiographic findings explain brain injury – critical brain injury -No eye movement (doll’s eye); no pupillary response -No corneal reflexes -No cough or gag reflex; no motor response to pain -Apnea test – failed -Ancillary testing if needed: -Brain scan, angiogram, EEG, MRI, CT angiogram

Answer 37

-Withdrawal of care -Ventilator withdrawn in OR -Cardiac arrest within 60(90) minutes -Death declared 2 - 5 minutes after cardiac arrest* -NRP, new technique to reverse ischemia

Answer 38

-Living donor program. -No reliance on dead donor rule. -“Permanent unconsciousness” and “Imminently dying” would require specific definitions and societal acceptance. -Withdrawal of care for any reason could be acceptable for “immanent death.”

Answer 39

When the marital act of sexual intercourse is not able to attain its procreative purpose, assistance that does not separate the unitive and procreative ends of the act, and does not substitute for the marital act itself, may be used to help married couples conceive.

Answer 40

Those techniques of assisted conception that respect the unitive and procreative meanings of sexual intercourse and do not involve the destruction of human embryos, or their deliberate generation in such numbers that it is clearly envisaged that all cannot implant and some are simply being used to maximize the chances of others implanting, may be used as therapies for infertility.

Answer 41

Heterologous fertilization (that is, any technique used to achieve conception by the use of gametes coming from at least one donor other than the spouses) is prohibited because it is contrary to the covenant of marriage, the unity of the spouses, and the dignity proper to parents and the child.28

Answer 42

Homologous artificial fertilization (that is, any technique used to achieve conception using the gametes of the two spouses joined in marriage) is prohibited when it separates procreation from the marital act in its unitive significance (e.g., any technique used to achieve extracorporeal conception).

Answer 43

Because of the dignity of the child and of marriage, and because of the uniqueness of the mother-child relationship, participation in contracts or arrangements for surrogate motherhood is not permitted. Moreover, the commercialization of such surrogacy denigrates the dignity of women, especially the poor.

Answer 44

A Catholic health care institution that provides treatment for infertility should offer not only technical assistance to infertile couples but also should help couples pursue other solutions (e.g., counseling, adoption).

Answer 45

Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo. Catholic health care institutions are not to provide abortion services, even based upon the principle of material cooperation. In this context, Catholic health care institutions need to be concerned about the danger of scandal in any association with abortion providers.

Answer 46

Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child.

Answer 47

In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion

Answer 48

For a proportionate reason, labor may be induced after the fetus is viable

Answer 49

Prenatal diagnosis is permitted when the procedure does not threaten the life or physical integrity of the unborn child or the mother and does not subject them to disproportionate risks; when the diagnosis can provide information to guide preventative care for the mother or pre- or postnatal care for the child; and when the parents, or at least the mother, give free and informed consent. Prenatal diagnosis is not permitted when undertaken with the intention of aborting an unborn child with a serious defect

Answer 50

Catholic health institutions may not promote or condone contraceptive practices but should provide, for married couples and the medical staff who counsel them, instruction both about the Church’s teaching on responsible parenthood and in methods of natural family planning.

Answer 51

Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology, and a simpler treatment is not available

Answer 52

pregnant woman has a cancerous womb that must be removed, removing it would produce an indirect abortion.

Answer 53

1. The infant is chronically and irreversibly comatose; 2. The provision of such treatment would merely prolong dying, not be effective in ameliorating or correcting all of the infant’s life-threatening conditions, or otherwise be futile in terms of the survival of the infant; or 3. The provision of such treatment would be virtually futile in terms of the survival of the infant and the treatment itself under such circumstances would be inhumane.

Answer 54

-Treatment for addiction to or use of drugs. -Treatment for sexually transmitted diseases. -Contraception and Pregnancy. -Abortion, 48 hours after notification of parent or guardian. Notification is in person, by sealed envelope marked “Personal and Confidential”.

Answer 55

-Treatment for addiction to or use of drugs. -Treatment for sexually transmitted diseases. -Contraception and Pregnancy. -Abortion, 48 hours after notification of parent or guardian. Notification is in person, by sealed envelope marked “Personal and Confidential”.

Answer 56

-Sole responsibility for their support -Married or living away from parents -Armed forces -No “Mature Minor” designation. -Ethical obligation to involve minors

Answer 57

-Best Interest of minor is paramount! -Parental authority is very important. -Disagreements between minor and parent(s) or guardians need mediation. -Privately with medical staff. -Legal venue.

Answer 58

-A minor patient’s non-binding expression of agreement to recommended treatment. -Informed consent is a legality whereby the legal guardian gives permission for the recommended treatment.

Answer 59

-Harder issue than Assent. -Non-binding refusal of care by a minor. -As the gravity of the illness and risk of treatment increase, refusal by a minor is harder. -Courts will usually go with preservation of life overall arguments except for religious arguments – but not always.

Ethics Final Flashcards

(83 cards)