Topic 10: end of life + euthanasia Flashcards
(27 cards)
Describe palliative care
- Specialized approach = improve quality of life = patients with life-limiting illnesses
- Focus = relief from suffering + support patient/family
- Not hastening/postponing death = ensure comfort + dignity + respect
Give the types of holistic support
1) Physical:
- Pain management = opioids
- Symptom control
2) Psychological:
- Addressing fear/anxiety/distress = patient + families
3) Social:
- Support family/caregivers
4) Spiritual:
- Help patients find meaning + peace
When are patients considered approaching end of life?
- Likely to die within 12 months
- Advanced + progressive + incurable
- Reduced life expectancy
- Neonates = poor survival
- Vegetative state
Give the 4 principles relating to palliative care
1) Autonomy: respecting patient wishes on care
2) Beneficence: best interest to relieve suffering
3) Non-maleficence: avoid treatment = unnecessary harm
4) Justice: fair access + treatment withdrawal decisions
Give barriers to equitable care
- Older/disabled individuals
- Ethnic minorities = poorer care
- Therefore physical/communication/provider misconception = boundries
Which human rights act applies to end of life care decisions?
- Act 1998
Define presumption of capacity
- Assume all adult = capacity until proven otherwise
- Cannot assume based on = age + disability + beliefs
Give the 2 decision making models
1) Patients with capacity:
2) Patients lacking capacity
Explain patients with capacity
- Assess condition with patient
- Consider medical history + views
- Use clinical judgment
- Explain options + risk/benefits = patient decides even if irrational
- Explore reasons for choice + explain options further
Explain patients lacking capacity
- Identify decisions + responsible person
- Check legal advance decisions + proxy
- If no advance/proxy = assess overall benefit
- Consult family + team = consider patient preferences + values + least restrictive option
- In case of disagreement = consider 2nd opinions
Define withholding treatement
- Deciding not to start medical intervention
Define withdrawing treatment
- Stopping ongoing medical intervention
Describe the ethical considerations of withholding vs withdrawing treatment
- Both can be done legally/ethically = if in best interest
- Withdrawing = ethically challenging = active step
- Kep principle = whether continuing treatment benefits patient OR prolongs suffering
Define life-sustaining treatments
- Vent + feeding tubes + dialysis
- Continuing = futile = more suffering than benefit
Give the ethical justifications of withdrawing treatment
1) Patient autonomy:
- Can refuse treatment
- Advance directives /wills
- DNAR orders = discussed with patient + family
2) Best interest:
- When lack of capacity
3) Proportionality:
- Benefit vs burden of continued treatment
Describe the UK legal framework for withdrawing life-sustaining treatment
UK LEGAL FRAMEWORK:
1) Mental Capacity Act 2005
2) Human rights act 1998
Describe the doctrine of double effect
- Argues action with good/bad effects ethically permissible
- If act is morally good/neutral
- Intended effect good + bad effect not intended
- Bad effect not means to achieve good effect
- Proportionately grave reason = allow bad effect
Explain the application of DDE in palliative care
- Pain-relief meds = may shorten life = intention to relieve pain = not cause death
- Withholding = life-prolonging treatment burdensome = intention is best interest NOT death
- Withdrawing = stopping treatment when non-beneficial
- DDE justifies allowing natural death
Define euthanasia
- Death by intention of 1 person to kill another using most gentle + easy means possible
- Motivated by best interests of person dying
- Voluntary = patient consent
- Involuntary = against pateint wishes
- Non-voluntary = without consent but wishes unknown
Define physician-assisted suicide
- Doctor provides fatal prescription to patient = suicide
Define assisted dying
- Euthanasia + PAS
Give arguments defending legitimacy of euthanasia
1) Respect of autonomy = human freedom = respect for autonmy incomplete without allowing
> Person’s right to die doesn’t create right for someone to assist their death
2) Compassion = can end suffering that cannot be relieved otherwise
3) Intrinsic value of life = life value shaped by individual living it
Give arguments against legitimacy of euthanasia
1) Principle based = life not individual’s to dispose = belongs to sovereign/deity = sanctity of life moral grounds
2) Autonomy = concept depends on life = ending life contradicts basis of autonomy
3) Alternatives = pain management + palliative care
4) Slippery slope = permitting euthanasia can lead to involuntary euthanasia
Give the legal framework of euthanasia in UK
- Illegal
- Different legal framework for euthanasia + assisted suicide
- Ethical/prosecutorial = role in enforcement
- Legal status euthanasia = considered murder/manslaughter
- Legal status assisted suicide = illegal under suicide act 1961
