UNIT 2 Flashcards
1
Q
is the way people experience and express themselves sexually
A
Human sexuality
2
Q
Human sexuality involves
A
biological, erotic, physical, emotional, social, or spiritual feelings and behaviors.
3
Q
largely concern the human reproductive functions, including the human sexual response cycle.
A
The biological and physical aspects of sexuality
4
Q
is their pattern of sexual interest in the opposite or same sex.
A
sexual orientation
5
Q
include bonds between individuals that are expressed through profound feelings or physical manifestations of love, trust, and care.
A
Physical and emotional aspects of sexuality
6
Q
deal with the effects of human society on one’s sexuality,
A
Social aspects
7
Q
concerns an individual’s spiritual connection with others.
A
spirituality
8
Q
also affects and is affected by cultural, political, legal, philosophical, moral, ethical, and religious aspects of life
A
Sexuality
9
Q
Under the Family Code of the Philippines (FC), ____ is defined as a special contact of permanent union between a man and a woman entered into in accordance with law for the establishment of conjugal and family life
A
marriage
10
Q
It is the foundation of the family and inviolable social institution whose nature, consequences, and incidents are governed by law and not subject to stipulation,
A
Marriage
11
Q
Essential Requisites and Formal Requisites in Marriage
* Essential requisites:
A
Legal capacity of the contracting parties who must be a male and a female
Consent freely given in the presence of the solemnizing officer.
12
Q
Essential Requisites and Formal Requisites in Marriage
* Formal requisites:
A
A valid marriage license except in marriage of exceptional circumstances
A marriage ceremony which takes place with the appearance of the contracting parties before the solemnizing officer and their personal declaration that they take each other as husband and wife in the presence of not less than 2 witnesses of legal age.
13
Q
Parental consent is necessary when the contracting parties are between the ages of ___ years of age
A
18-21
14
Q
Rights and Obligations Between Husband and Wife
Personal obligations of the spouses to each other:
A
- Live together
- To observe mutual love, respect and fidelity
- To render mutual help and support
15
Q
is sexual activity between two people who are not married to each other.
A
Premarital sex
16
Q
is sex occurring outside marriage, usually referring to when a married person engages in sexual activity with someone other than their marriage partner.
A
Extramarital sex
17
Q
Commonly there are moral as well as religious objections to sexual relationships by a married person outside the marriage, and such activity is often referred to in law or religion as
A
adultery
18
Q
is the deliberate use of artificial methods or other techniques to prevent pregnancy as a consequence of sexual intercourse
A
Contraception
19
Q
The major forms of artificial contraception are
A
barrier methods
20
Q
barrier methods, of which the most common is the
A
condom
21
Q
which contains synthetic sex hormones that prevent ovulation in the female;
A
the contraceptive pill,
22
Q
which prevent the fertilized ovum from implanting in the uterus; and male or female sterilization.
A
intrauterine devices, such as the coil,
23
Q
Those who say contraception is morally wrong do so for a variety of reasons.
1. Contraception is inherently wrong
A
Contraception is unnatural
Contraception is anti-life
Contraception is a form of abortion
Contraception separates sex from reproduction
24
Q
- Contraception brings bad consequences
A
These are consequentialist arguments against contraception.
(consequentialism is the doctrine that the morality of an action is to be judged solely by its consequences)
Contraception carries health risks
The “contraceptive culture” is dangerous
Contraception prevents potential human beings being conceived
Contraception prevents people who might benefit humanity from being born
Contraception can be used as a eugenic (selection of desired heritable characteristics in order to improve future generations) tool
Contraception is often misused in mass population control programs in a racist way
Mass population control programs can be a form of cultural imperialism or a misuse of power
Contraception may lead to depopulation
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3. Contraception leads to "immoral behavior"
Contraception makes it easier for people to have sex outside marriage
Contraception leads to widespread sexual immorality
Contraception allows people (even married people) to have sex purely for enjoyment
26
4. Contraception is Anti-life
This argument is based on the premise that life is a good thing. Holders of this view argue that contraception is morally wrong because:
Life is a fundamental good - it is a good thing
Those who use contraception are engaged in an intentionally "anti-life" act because they intend to prevent a new life coming into being
They therefore have a bad intention
It is always morally wrong to do something with a bad intention
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5. Contraception is a Form of Abortion
Some birth control techniques can operate by preventing the implantation and development of a fertilized egg.
Those opposed to such methods say that this amounts to an abortion, and that if abortion is wrong then those forms of contraception must also be wrong.
The forms of contraception included in this objection are:
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can prevent implantation of a fertilized egg, even though this is not the main way they work
Most modern birth control pills
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b) The "morning-after" pill
This is also capable of operating by preventing implantation of a fertilized egg
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This can operate by preventing implantation of a fertilized egg
c) The IUD
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Contraception may damage the health of the individual using it in two ways; either through side effects of the contraceptive or because using contraception allows people to have more sexual partners and thus increases the possibility of catching a sexually transmitted disease.
6. Contraception Carries Health Risks
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7. Side Effects of Contraception
Some forms of contraception do have side effects that damage health while others have not been shown to have health risks.
Users considering a particular form of birth control should:
make sure they are aware of its risks
compare those risks to the risks of other forms of contraception
compare those risks to the risks that go with having a baby
take an informed decision based on that information
This is probably not an ethical objection to contraception itself, although it does involve the ethical issue of informed consent to medical treatment.
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This is certainly true, since sexual intercourse without contraception carries a significant risk of conceiving a child, which most of those having sex outside marriage would regard as a deterrent.
8. Contraception makes it easier for people to have sex outside marriage
34
People think separating sex from marriage is wrong because:
It makes immoral behavior less risky
It undermines public morality by making it more likely that people will have sex outside marriage
It weakens the family
35
is the deliberate introduction of sperm into a female's cervix or uterine cavity for the purpose of achieving a pregnancy through in vivo fertilization by means other than sexual intercourse.
Artificial insemination
36
The Beneficiaries of Artificial Insemination
* Are women who desire to give birth to their own child who may be single, women who are in a lesbian relationship
* Women who are in a heterosexual relationship but with a male partner who is infertile or who has a physical impairment which prevents full intercourse from taking place.
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Preparations Artificial Insemination
hours from the release of the ovum. To increase the chance of success, the woman's menstrual cycle is closely observed, often using ovulation kits, ultrasounds or blood tests, such as basal body temperature tests over, noting the color and texture of the vaginal mucus, and the softness of the nose of her cervix. To improve the success rate of AI, drugs to create a stimulated cycle may be used, but the use of such drugs also results in an increased chance of a multiple birth.
Pre- and post-concentration of motile sperm is counted. Sperm from a sperm bank will be frozen and quarantined for a period, and the donor will be tested before and after production of the sample to ensure that he does not carry a transmissible disease. For fresh shipping, a semen extender is used.
If sperm is provided by a private donor, either directly or through a sperm agency, it is usually supplied fresh, not frozen, and it will not be quarantined. Donor sperm provided in this way may be given directly to the recipient woman or her partner, or it may be transported in specially insulated containers. Some donors have their own freezing apparatus to freeze and store their sperm.
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T OR F
The risk of conceiving twins or triplets increases if a woman receives IUI at the same time as other fertility medication, such as gonadotrophin. A pregnancy with more than one fetus increases the chances of complications, such as premature birth or miscarriage.
TRUE
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can the ovaries to swell after combining fertility medication and IUI. It is rare, and symptoms are usually mild-to-moderate, but it can sometimes have serious complications.
Ovarian hyperstimulation syndrome (OHSS)
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symptoms include bloating, slight abdominal pain, and possibly nausea and vomiting.
In mild cases of OHSS,
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may feature dehydration, chest pain and shortness of breath.
More severe cases
42
is a complex series of procedures used to help with fertility or prevent genetic problems and assist with the conception of a child.
In vitro fertilization (IVF)
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mature eggs are collected (retrieved) from ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs (embryos) are transferred to a uterus.
During IVF,
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One full cycle of IVF takes about ____ Sometimes these steps are split into different parts and the process can take longer.
three weeks.
45
IVF may be an option if you or your partner has:
* Fallopian tube damage or blockage.
* Ovulation disorders.
* Endometriosis.
* Uterine fibroids.
* Previous tubal sterilization or removal.
* Impaired sperm production or function.
* Unexplained infertility.
* A genetic disorder.
* Fertility preservation for cancer or other health conditions.
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makes it difficult for an egg to be fertilized or for an embryo to travel to the uterus.
* Fallopian tube damage or blockage. Fallopian tube damage or blockage
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. If ovulation is infrequent or absent, fewer eggs are available for fertilization.
* Ovulation disorders
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occurs when the uterine tissue implants and grows outside of the uterus — often affecting the function of the ovaries, uterus and fallopian tubes.
Endometriosis
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are benign tumors in the wall of the uterus and are common in women in their 30s and 40s. Fibroids can interfere with implantation of the fertilized egg.
Fibroids
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If you've had ___— a type of sterilization in which your fallopian tubes are cut or blocked to permanently prevent pregnancy — and want to conceive, IVF may be an alternative to tubal ligation reversal.
tubal ligation
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Below-average sperm concentration, weak movement of sperm (poor mobility), or abnormalities in sperm size and shape can make it difficult for sperm to fertilize an egg. If semen abnormalities are found, your partner might need to see a specialist to determine if there are correctable problems or underlying health concerns.
* Impaired sperm production or function.
52
means no cause of infertility has been found despite evaluation for common causes.
Unexplained infertility
53
If you or your partner is at risk of passing on a genetic disorder to your child, you may be candidates for _____ — a procedure that involves IVF. After the eggs are harvested and fertilized, they're screened for certain genetic problems, although not all genetic problems can be found. Embryos that don't contain identified problems can be transferred to the uterus.
preimplantation genetic testing
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If you or your partner is at risk of passing on a genetic disorder to your child, you may be candidates for preimplantation genetic testing — a procedure that involves IVF. After the eggs are harvested and fertilized, they're screened for certain genetic problems, although not all genetic problems can be found. Embryos that don't contain identified problems can be transferred to the uterus.
* A genetic disorder.
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If you're about to start cancer treatment — such as radiation or chemotherapy — that could harm your fertility, IVF for fertility preservation may be an option. Women can have eggs harvested from their ovaries and frozen in an unfertilized state for later use. Or the eggs can be fertilized and frozen as embryos for future use.
* Fertility preservation for cancer or other health conditions.
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IVF increases the risk of multiple births if more than one embryo is transferred to your uterus. A pregnancy with multiple fetuses carries a higher risk of early labor and low birth weight than pregnancy with a single fetus does.
* Multiple births
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Research suggests that IVF slightly increases the risk that the baby will be born early or with a low birth weight.
* Premature delivery and low birth weight.
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to induce ovulation can cause ovarian hyperstimulation syndrome, in which your ovaries become swollen and painful.
* Ovarian hyperstimulation syndrome. Use of injectable fertility drugs, such as human chorionic gonadotropin (HCG),
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The rate of miscarriage for women who conceive using IVF with fresh embryos is similar to that of women who conceive naturally — about 15% to 25% — but the rate increases with maternal age.
* Miscarriage.
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Use of an aspirating needle to collect eggs could possibly cause bleeding, infection or damage to the bowel, bladder or a blood vessel. Risks are also associated with sedation and general anesthesia, if used.
* Egg-retrieval procedure complications.
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. About 2% to 5% of women who use IVF will have an ectopic pregnancy — when the fertilized egg implants outside the uterus, usually in a fallopian tube. The fertilized egg can't survive outside the uterus, and there's no way to continue the pregnancy.
* Ectopic pregnancy
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* Although some early studies suggested there may be a link between certain medications used to stimulate egg growth and the development of a specific type of ovarian tumor, more-recent studies do not support these findings. There does not appear to be a significantly increased risk of breast, endometrial, cervical or ovarian cancer after IVF.
Cancer.
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Use of IVF can be financially, physically and emotionally draining. Support from counselors, family and friends can help you and your partner through the ups and downs of infertility treatment.
* Stress.
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Risks of IVF include:
* Multiple births.
* Premature delivery and low birth weight.
* Ovarian hyperstimulation syndrome.
* Symptoms typically last a week and include mild abdominal pain, bloating, nausea, vomiting and diarrhea. If you become pregnant, however, your symptoms might last several weeks. Rarely, it's possible to develop a more severe form of ovarian hyperstimulation syndrome that can also cause rapid weight gain and shortness of breath.
* Miscarriage.
* Egg-retrieval procedure complications.
* Ectopic pregnancy.
* Birth defects.
* Cancer.
* Stress.
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The chances of giving birth to a healthy baby after using IVF depend on various factors, including:
* Maternal age.
* Embryo status.
* Reproductive history.
* Cause of infertility.
* Lifestyle factors.
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. The younger you are, the more likely you are to get pregnant and give birth to a healthy baby using your own eggs during IVF. Women age 41 and older are often counseled to consider using donor eggs during IVF to increase the chances of success.
* Maternal age
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Transfer of embryos that are more developed is associated with higher pregnancy rates compared with less-developed embryos (day two or three). However, not all embryos survive the development process. Talk with your doctor or other care provider about your specific situation.
* Embryo status.
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* Women who've previously given birth are more likely to be able to get pregnant using IVF than are women who've never given birth. Success rates are lower for women who've previously used IVF multiple times but didn't get pregnant.
Reproductive history.
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. Having a normal supply of eggs increases your chances of being able to get pregnant using IVF. Women who have severe endometriosis are less likely to be able to get pregnant using IVF than are women who have unexplained infertility.
* Cause of infertility
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Women who smoke typically have fewer eggs retrieved during IVF and may miscarry more often. Smoking can lower a woman's chance of success using IVF by 50%. Obesity can decrease your chances of getting pregnant and having a baby. Use of alcohol, recreational drugs, excessive caffeine and certain medications also can be harmful.
* Lifestyle factors.
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There are several moral issues with in vitro.
First of all, the child is created outside the womb by human devices as a sperm and a harvested egg are combined.
Second, many children (embryos) are created and some are frozen for later use while several are placed in the mother's womb. The survival for these embryos is low, sometimes quoted around 25%. So in essence, multiple children are created, knowing that most of them will not live. Some physicians only place 2-3 embryos in the mother, hoping that one or all of them will survive. Other physicians place more embryos in the mother, and if too many live, they then abort the "extras" and leave a more "manageable" number of embryos in the womb.
The frozen embryos have an uncertain fate. Some of them remain frozen for an inestimable period of time, children that have been created and then frozen! Does it seem right to create life and then leave it? Some of the frozen embryos may be thawed later for a repeat cycle of IVF, and most do not survive. In some cases, embryos are donated to other couples or some may be donated for research (i.e.: killing them in the name of scientific study).
The overall problem with IVF is that it destroys life as it creates life. Meaning, the chance of one child surviving carries with it the necessity of many other children (embryos) having been created and then dying. So for the one surviving child, many other children have been given life (combining sperm and egg) with the knowledge that most of them won't make it.
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is a woman who helps a couple to have a child by carrying to term an embryo conceived by the couple and transferred to her uterus, or by being inseminated with the man's sperm and either donating the embryo for transfer to the woman's uterus or carrying it to term.
Surrogate mother
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There are two kinds of surrogate mother
Traditional surrogate
Gestational surrogates
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It's a woman who gets artificially inseminated with the father's sperm. She then carries the baby and delivers it for you and your partner to raise.
1. Traditional surrogate.
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is the baby's biological mother. That's because it was her egg that was fertilized by the father's sperm. Donor sperm can also be used.
A traditional surrogate
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A technique called "in vitro fertilization" (IVF) now makes it possible to gather eggs from the mother, fertilize them with sperm from the father, and place the embryo into the uterus of a gestational surrogate. The surrogate then carries the baby until birth. She doesn't have any genetic ties to the child because it wasn't her egg that was used.
2. Gestational surrogates.
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A gestational surrogate is called the
The biological mother, though, is still the woman whose egg was fertilized.
"birth mother."
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The Ethical Issues that are Pertinent in the Surrogacy Process
While there are many religious organizations that frown upon the process of surrogacy, this concept is oftentimes the only option for some individuals to start a family. It is for this reason that some highly controversial and key ethical issues be addressed.
Attachment with the Gestational Mother –
Involvement with the Gestational Mother –
Identity of the Child
factor of surrogate mother compensation. It is typically expected that the intended parents of the child will reimburse the surrogate mother for her medical and other related expenses. This can include an amount for her hospitalization as well as incidentals such as her maternity clothing, meals, and other similar costs that she may be out during her time of pregnancy.
There are also surrogate situations where the individual or couple who are the intended parents will pay a fee to the surrogate mother for carrying their baby. With this in mind, it is thought by some that surrogacy could be thought of as being a luxury that is only available to the wealthy – and in some cases it could even be thought of as pregnancy-for-hire.
In any case, however, the process that allows for a loving individual or parents to have a child of their own can allow intended parents to follow through on their intentions of starting a family, regardless of any medical or other factors that would otherwise prevent them from being able to do so.
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In a surrogate situation, the gestational mother is the woman who carries the baby to term. This can be a very taxing process both physically and emotionally – and unique in that after the surrogate mother physically carries the baby throughout the pregnancy, she needs to physically and emotionally detach herself from the child once it is born.
Attachment with the Gestational Mother –
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Because the gestational mother will not likely be the child's primary caretaker, there could be legal questions that arise in terms of what – if any – involvement she will have with the child once born.
Involvement with the Gestational Mother –
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There are also ethical considerations that are brought to mind in terms of informing the child of his or her surrogate mother, as doing so may have an effect on the child's self-identity.
Identity of the Child –
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is the premature termination of pregnancy prior to birth. Induced abortion is caused by the woman herself or by another, usually a medical doctor
Abortion
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Point of Argument on Abortion
* Fetus is not an actual human life in the womb after the 12th week, when the brain structure is essentially complete and a fetal electrocardiogram through the pregnant woman can pick up heart activity.
* When the child breathes on its own, are the only points at which human life begins.
* Human being able to survive without life support of some kind.
* If they cannot breathe for themselves or eat and drink on their own they are not actually human beings.
* Once born-they are considered as human.
* “At what point in development of the conceptus to be valued to the extent that terminating its life would be equivalent to terminating the life of people who are already born?”
* Genetic View – human life is to be valued from conception onward.
* The Strong Prochoice Position – human life does not have the value until birth.
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Arguments Against Abortion
Human life starts at conception (the chromosomes from the sperm and ovum are united) then a human being exists that must be valued in the same way as if “he or she” were already born.
Safest position to hold: by valuing a conceptus as a human from conception onward we are ensuring that we do not act immorally or irreverently toward human life, especially innocent, unborn life
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The Sanctity of Life Argument
Every unborn, innocent child must be regarded as human person with all the rights of a human person from the moment of conception onward. The conceptus not only has the right to life, but also that his/her right is absolute. Absolute overrides all other rights that might come into conflict with it.
For instance, a woman’s right to determine the course of her own procreative life or even her right to decide between her own life and the life of her conceptus if her pregnancy is complicated in some way.
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Potential Dangers of Abortion
Abortion increases a woman’s chances of having miscarriages in later pregnancies (especially for young girls who have had an abortion). Self-induced abortion is the most dangerous of all abortions because they are not done under medical supervision. Can cause complications like infections and hemorrhage which can kill both the fetus and the mother.
It is psychologically destructive to a woman to authorize the “killing of her baby”. A woman who has committed such terrible act has to live with a great deal of guilt. Emotional scars will never be eradicated from the psyche.
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from Greek word thanatos means
"death"
88
(from Greek word thanatos means "death") is the practice of intentionally ending a life to relieve pain and suffering.
Euthanasia
89
select committee on medical ethics defines euthanasia as "a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering".
The British House of Lords
90
euthanasia is understood as "termination of life by a doctor at the request of a patient".
In the Netherlands and Belgium,
91
however, does not use the term 'euthanasia' but includes the concept under the broader definition of "assisted suicide and termination of life on request".
The Dutch law,
92
Euthanasia is Categorized in Different Ways
1. Voluntary euthanasia
2. Non-voluntary euthanasia i
3. Involuntary euthanasia
4. Passive euthanasia
5. Active euthanasia
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is conducted with the consent of the patient. When the patient brings about their own death with the assistance of a physician, the term assisted suicide is often used instead.
1. Voluntary euthanasia
94
s conducted when the consent of the patient is unavailable. Non-voluntary euthanasia involves someone else making the decision to end someone’s life. A close family member usually makes the decision. This is generally done when someone is completely unconscious or permanently incapacitated.
2. Non-voluntary euthanasia i
95
(without asking consent or against the patient's will) is also illegal in all countries and is usually considered murder.
3. Involuntary euthanasia
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entails the withdrawing life support from someone who’s showing no signs of brain activity.
4. Passive euthanasia
97
entails the use of lethal substances or forces (such as administering a lethal injection), and is the more controversial.
5. Active euthanasia
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1. In the United States, PAS is legal in:
Washington
Oregon
California
Colorado
Montana
Vermont
Washington, D.C.
Hawaii (beginning in 2019)
99
2. Outside the United States, PAS is legal in:
Switzerland
Germany
Japan
Netherlands
Belgium
Luxembourg
Colombia
Canada
100
Some people believe euthanasia is murder and find it unacceptable for moral reasons. Many also argue that the ability to decide your own death weakens the sanctity of life. In addition, many churches, religious groups, and faith organizations argue against euthanasia for similar reasons.
1. Morality and religion
101
Physician Assisted Suicide is only legal if someone is mentally capable of making the choice. However, determining someone’s mental capabilities isn’t very straightforward. One study of Trusted Source found that doctors aren’t always capable of recognizing when someone is fit to make the decision.
2. Physician judgement
102
Some doctors and opponents of PAS are concerned about the ethical complications doctors could face. For more than 2,500 years, doctors have taken the Hippocratic oath. This oath encourages doctors to care for and never harm those under their care.
Some argue that the Hippocratic oath supports PAS since it ends suffering and brings no more harm. On the other hand, some debate it results in harm to the person and their loved ones, who must watch their loved one suffer.
3. Ethics
103
Some argue that the Hippocratic oath supports PAS since it ends suffering and brings no more harm. On the other hand, some debate it results in harm to the person and their loved ones, who must watch their loved one suffer.
3. Ethics
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“Death with dignity” is a movement that encourages legislatures to allow people to decide how they want to die. Some people simply don’t want to go through a long dying process, often out of concern of the burden it puts on their loved ones.
4. Personal choice
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is a principle of implied protection regarding aspects of life that are said to be holy, sacred, or otherwise of such value that they are not to be violated.
The inviolability or sanctity of life
106
is a phrase that in recent decades became commonplace in the moral and political debates concerning a wide range of bioethical issues: abortion, embryo research, cloning, genetic engineering, euthanasia, and others
“sanctity of life”
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is the act of killing yourself, most often as a result of depression or other mental illness.
Suicide
108
Suicide rates are highest for ____, but are increasing alarmingly in young people aged ___
men over 69 ; 15 to 24.
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Suicide Warning Signs
Be concerned if someone you know:
* Talks about committing suicide
* Has trouble eating or sleeping
* Exhibits drastic changes in behavior
* Withdraws from friends or social activities
* Loses interest in school, work or hobbies
* Prepares for death by writing a will and making final arrangements
* Gives away prized possessions
* Has attempted suicide before
* Takes unnecessary risks
* Has recently experienced serious losses
* Seems preoccupied with death and dying
* Loses interest in his or her personal appearance
* Increases alcohol or drug use.
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Effective Suicide Prevention
1. Limiting access to methods of suicide—such as firearms, drugs, and poisons.
2. Treating mental disorders and substance misuse.
3. Careful media reporting about suicide.
4. Improving economic conditions.
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means "bad death” and is considered a common fault of modern medicine.
Dysthanasia
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occurs when a person who is dying has their biological life extended through technological means without regard to the person's quality of life. . Technologies such as an implantable cardioverter defibrillator, artificial ventilation, ventricular assist devices, and extracorporeal membrane oxygenation can extend the dying process.
. Dysthanasia
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is a term generally used when a person is seen to be kept alive artificially in a condition where, otherwise, they cannot survive.
Dysthanasia
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refers to the art of promoting a humane and correct death, not subjecting patients to dysthanasia and not abbreviating death either, that is, subjecting them to euthanasia.
Orthotanasia
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In end-of-life care, symptoms of discomfort are mainly managed by drug therapy, the guidelines for which are mainly based on expert opinions.
Administration of Drugs to the Dying
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the most frequently prescribed drugs in the palliative setting are ___. These drugs are given to relieve symptoms such as pain, restlessness and agitation, which are frequently seen in advanced cancer.
morphine, midazolam and haloperidol.
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are legal documents that allow you to spell out your decisions about end-of-life care ahead of time. They give you a way to tell your wishes to family, friends, and health care professionals and to avoid confusion later on.
Advance directives
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Types of Advance Directives
1. Living will
2. Durable power of attorney for health care/Medical power of attorney
3. POLST (Physician Orders for Life-Sustaining Treatment)
4. Do not resuscitate (DNR) orders
5. Organ and tissue donation
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is a legal document used to state certain future health care decisions only when a person becomes unable to make the decisions and choices on their own.
Living will
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is only used at the end of life if a person is terminally ill (can't be cured) or permanently unconscious
The living will
121
describe the type of medical treatment the person would want or not want to receive in these situations. It can describe under what conditions an attempt to prolong life should be started or stopped. This applies to treatments including, but not limited to dialysis, tube feedings, or actual life support (such as the use of breathing machines).
The living will
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Things to think about when writing a living will
If you want the use of equipment such as dialysis machines (kidney machines) or ventilators (breathing machines) to help keep you alive.
Do not resuscitate orders (instructions not to use CPR if breathing or heartbeat stops).
If you want fluid or liquid (usually by IV) and/or food (tube feeding into your stomach) if you couldn't eat or drink.
If you want treatment for pain, nausea, or other symptoms, even if you can't make other decisions (this may be called comfort care or palliative care).
If you want to donate your organs or other body tissues after death.
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, also known as a medical power of attorney, is a legal document in which you name a person to be a proxy (agent) to make all your health care decisions if you become unable to do so.
durable power of attorney for health care
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should be someone who knows you well and someone you trust to carry out your wishes.
The person you name as a proxy or agent
125
form also helps describe your wishes for health care, but it is not an advance directive.
POLST (Physician Orders for Life-Sustaining Treatment)
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has a set of specific medical orders that a seriously ill person can fill in and ask their health care provider to sign.
POLST form
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form addresses your wishes in an emergency, such as whether to use CPR (cardiopulmonary resuscitation) in an emergency, or whether to go to a hospital in an emergency and be put on a breathing machine if necessary, or stay where you are and be made comfortable.
POLST
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form has to be signed by a qualified member of your health care team, such as your doctor. Emergency personnel, like paramedics and EMTs (Emergency Medical Technicians) can't use an advance directive, but they can use a ____ form.
POLST
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means medical staff will try to re-start your heart and breathing using methods such as CPR (cardiopulmonary resuscitation) and AED (automated external defibrillator). In some cases, they may also use life-sustaining devices such as breathing machines.
Resuscitation
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order means that if you stop breathing or your heart stops, nothing will be done to try to keep you alive.
Do Not Resuscitate or DNR
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can be included in your advance directive. Many states also provide organ donor cards or add notations to your driver's license.
Organ and tissue donation
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can be a highly challenging, emotional time. It can become evident that in spite of the best care, attention, and treatment, your loved one is approaching the end of their life
The final stages of a terminal illness
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. At this point, the focus usually changes to making them as comfortable as possible in order to make the most of the time they have left.
End of Life Care Plan
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is also a time for saying goodbye to your loved one, to resolve any differences, forgive any grudges, and to express your love
Late-stage care
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the following are signs that you may want to talk to your loved one about hospice and palliative care, rather than curative care options:
* Your loved one has made multiple trips to the emergency room, their condition has been stabilized, but the illness continues to progress significantly, affecting their quality of life.
* They’ve been admitted to the hospital several times within the last year with the same or worsening symptoms.
* They wish to remain at home, rather than spend time in the hospital.
* They have decided to stop receiving treatments for their disease.
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As your loved one enters late-stage or end-of-life care, their needs can change, impacting the demands you’ll now face as their caregiver. This can include the following areas:
1. Practical care and assistance.
2. Comfort and dignity.
3. Respite Care.
4. Grief support
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Perhaps your loved one can no longer talk, sit, walk, eat, or make sense of the world. Routine activities, including bathing, feeding, dressing, and turning may require total support and increased physical strength on your part as their caregiver. You can find support for these tasks from personal care assistants, a hospice team, or physician-ordered nursing services.
1. Practical care and assistance
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Even if your patient’s cognitive and memory functions are depleted, their capacity to feel frightened or at peace, loved or lonely, and sad or secure remains. Regardless of where they’re being cared for—at home, in a hospital, or at a hospice facility—the most helpful interventions are those which ease pain and discomfort and provide the chance for them to experience meaningful connections to family and loved ones.
2. Comfort and dignity.
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can give you and your family a break from the intensity of end-of-life caregiving. It may be simply a case of having a hospice volunteer sit with the patient for a few hours so you can meet friends for coffee or watch a movie, or it could involve the patient having a brief inpatient stay in a hospice facility.
Respite care
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Anticipating your loved one’s death can produce reactions from relief to sadness to feeling numb. Consulting bereavement specialists or spiritual advisors before your loved one’s death can help you and your family prepare for the coming loss.
4. Grief support.
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The end-of-life journey is eased considerably when conversations regarding placement, treatment, and end-of-life wishes are held as early as possible. Consider hospice and palliative care services, spiritual practices, and memorial traditions before they are needed
Prepare early.
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Legal documents such as a living will, power of attorney, or advance directive can set forth a patient’s wishes for future health care so family members are all clear about their preferences.
Seek financial and legal advice while your loved one can participate.
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If your loved one did not prepare a living will or advance directive while competent to do so, act on what you know or feel their wishes are. Make a list of conversations and events that illustrate their views. To the extent possible, consider treatment, placement, and decisions about dying from the patient’s vantage point.
Focus on values.
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. Stress and grief resulting from your loved one’s deterioration can often create conflict between family members. If you are unable to agree on living arrangements, medical treatment, or end-of-life directives, ask a trained doctor, social worker, or hospice specialist for mediation assistance.
Address family conflicts
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Choose a primary decision maker who will manage information and coordinate family involvement and support. Even when families know their loved one’s wishes, implementing decisions for or against sustaining or life-prolonging treatments requires clear communication.
Communicate with family members.
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Children need honest, age-appropriate information about your loved one’s condition and any changes they perceive in you. They can be deeply affected by situations they don’t understand, and may benefit from drawing pictures or using puppets to simulate feelings, or hearing stories that explain events in terms they can grasp.
If children are involved, make efforts to include them.
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Drowsiness how to provide comfort
Plan visits and activities for times when the patient is most alert.
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Becoming unresponsive How to provide comfort
Many patients are still able to hear after they are no longer able to speak, so talk as if your loved one can hear.
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Confusion about time, place, identity of loved ones How to provide comfort
Speak calmly to help re-orient your loved one. Gently remind them of the time, date, and people who are with them.
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Loss of appetite, decreased need for food and fluids How to provide comfort
Let the patient choose if and when to eat or drink. Ice chips, water, or juice may be refreshing if the patient can swallow. Keep your loved one’s mouth and lips moist with products such as glycerin swabs and lip balm.
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Loss of bladder or bowel control How to provide comfort
Keep your loved one as clean, dry, and comfortable as possible. Place disposable pads on the bed beneath them and remove when they become soiled.
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Skin becoming cool to the touch How to provide comfort
Warm the patient with blankets but avoid electric blankets or heating pads, which can cause burns.
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Labored, irregular, shallow, or noisy breathing How to provide comfort
Breathing may be easier if the patient’s body is turned to the side and pillows are placed beneath their head and behind their back. A cool mist humidifier may also help.
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As a late-stage caregiver, you can offer emotional comfort to your loved one in several different ways:
Keep them company.
Refrain from burdening the patient with your feelings of fear, sadness and loss.
Allow your loved one to express their fears of death
Allow them to reminisce
Avoid withholding difficult information.
Honor their wishes
Respect the patient’s need for privacy
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. Talk to your loved one, read to them, watch movies together, or simply sit and hold their hand.
Keep them company
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Instead, talk to someone else about your feelings.
Refrain from burdening the patient with your feelings of fear, sadness and loss.
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It can be difficult to hear someone you love talk about leaving family and friends behind, but communicating their fears can help them come to terms with what’s happening. Try to listen without interrupting or arguing.
Allow your loved one to express their fears of death.
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Talking about their life and the past is another way some patients gain perspective on their life and the process of dying.
Allow them to reminisce.
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If they’re still able to comprehend, most patients prefer to be included in discussions about issues that concern them.
Avoid withholding difficult information.
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Reassure the patient that you will honor their wishes, such as advance directives and living wills, even if you don’t agree with them.
Honor their wishes.
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End-of-life care for many people is often a battle to preserve their dignity and end their life as comfortably as possible.
Respect the patient’s need for privacy.
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—when body systems shut down and death is imminent—typically lasts from a matter of days to a couple of weeks.
The end-of-life period
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o Although this is a painful time in so many ways, entering end-of-life care does offer you the opportunity to say goodbye to your loved one, an opportunity that many people who lose someone suddenly regret not having.
o If you wonder what to say to your loved one, palliative care physician Ira Byock in his book, The Four Things That Matter Most, identifies the things dying people most want to hear from family and friends: “Please forgive me.” “I forgive you.” “Thank you.” “I love you.”
Saying Goodbye
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No one can predict when that last minute will come so waiting for it puts a huge burden on you.
Don’t wait until the last minute to say goodbye.
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Hearing is the last sense to shut down, so even when your loved one appears comatose and unresponsive, there is a strong likelihood they can still hear what you are saying. Identify yourself and speak from the heart.
Just talk, even if your loved one appears unresponsive.
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Touch can be an important part of the last days and hours, too. Holding your loved one’s hand or giving them a kiss can bring comfort and closeness between you.
You don’t have to speak to say goodbye.
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You don’t have to formally issue a goodbye and say everything all at once. You can do it over days. Don’t worry about repeating yourself; this is about connecting with your loved one and saying what you feel so you are less likely to have regrets later about things left unsaid.
You can say goodbye many different times and in many different ways.
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As impossible as it may seem, taking care of yourself during your loved one’s final stages is critically important to avoid
burnout.
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This will require a broad range of skills and an awareness of the values which underpin this behavior. When providing end of life care, ensure you:
treat people compassionately
listen to people
communicate clearly and sensitively
identify and meet the communication needs of each individual
acknowledge pain and distress and take action
recognize when someone may be entering the last few days and hours of life
involve people in decisions about their care and respect their wishes
keep the person who is reaching the end of their life and those important to them up to date with any changes in condition
document a summary of conversations and decisions
seek further advice if needed
look after yourself and your colleagues and seek support if you need it
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refers to the process of evaluating and choosing among alternatives in a manner consistent with ethical principles.
Ethical decision-making
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, it is necessary to perceive and eliminate unethical options and select the best ethical alternative.
In making ethical decisions
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This act of working towards achieving greatest good for the patient by family members and by the physician can be termed under
“Virtue theory” of ethics.
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The process of making ethical decisions requires:
Commitment:
Consciousness:
Competency:
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The desire to do the right thing regardless of the cost.
Commitment:
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The awareness to act consistently and apply moral convictions to daily behavior.
Consciousness:
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The ability to collect and evaluate information, develop alternatives, and foresee potential consequences and risks
Competency:
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generate and sustain trust; demonstrate respect, responsibility, fairness and caring; and are consistent with good citizenship. These behaviors provide a foundation for making better decisions by setting the ground rules for our behavior.
Ethical decisions
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are effective if they accomplish what we want accomplished and if they advance our purposes.
Effective decisions
