1:3. Ethics of End of Life Care/Tissue Donation

Question 1

Competent patients can refuse treatment

T/F?

Answer 1

True

Question 2

Competent patients can demand treatment

T/F?

Answer 2

False

Question 3

Competent patients can refuse treatment in advance

T/F?

Answer 3

True

Question 4

Competent patients can appoint a proxy decision maker

T/F?

Answer 4

True

Question 5

What is advance refusal of treatment?

Answer 5

This is refusing treatment that may be needed in the future

Includes DNACPR/DNR

Question 6

What is DNR/DNACPR?

Answer 6

This is ‘Do Not Resuscitate’ or ‘Do Not Attempt Cardiopulmonary Resuscitation”
This is an advanced directive not to attempt resuscitation when patient’s life is at risk

Question 7

What must a DNR have to be legal?

Answer 7

• Must state that this applies even if patient’s life is at risk
• Must be in writing
• Must be signed
• Must be witnessed

Question 8

Describe end of life decisions:

- Patient has capacity?

Answer 8

Patient gets to decide

Decision is made with patient and multi-disciplinary team

Question 9

Describe end of life decisions:

- Patient has no capacity

Answer 9

Check for proxy (power of attorney) or advanced directive

If there are neither of these things:

• Consult those close to patient
• Consult health care team
• Do what is best for the patient
• Find out what the patient would have wanted if they could tell you

Question 10

When is it acceptable to withdraw/withold life saving treatment?

Answer 10

• If competent patient requests it
• If it is best for the patient
• If the treatment is futile

Question 11

Describe the Tony Bland case?

Answer 11

1st patient to be legally allowed to die due to withdrawal of treatment
Severe brain damage following Hillsborough accident
No signs of life
Decision by courts to allow treatment withdrawal

Question 12

When is it acceptable to give treatment that may cause death?

Answer 12

Under the Doctrine of Double Effect
This states that some actions that may be wrong and cause serious harm are permissible if they have the side effect of promoting some good end
Death is not the main cause of the treatment but a secondary side effect
Eg: Morphine for pain relief in palliative care

Question 13

Describe the legality of assisted suicide?

Answer 13

Illegal in the UK
Includes physician assisted suicide
Legal in some places

Question 14

What act involves tissue donation in Scotland?

Answer 14

Human Tissue Act (Scotland) 2006

Question 15

Describe two basic ethical rules of tissue donation?

Answer 15

• All tissue used appropriately

- Patients must consent for use of their tissues for anything other than their own treatment or investigation

Question 16

How do you consent to tissue donation before death?

Answer 16

Sign up to become an organ donor (Eg: On drivers license)

Question 17

How do you consent for tissue donation if the patient is close to death and unable to consent?

Answer 17

Speak to those close to the patient

Question 18

Describe tissue donation in the UK?

Answer 18

Opt-in system
Consent is not assumed
Consent is required for tissue use

Question 19

Describe tissue donation in places that have a different system to the UK?

Answer 19

Opt-out

Consent is assumed unless there is reason to believe otherwise (person has opted out)