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MED 105- MEDICAL ETHICS > 19. ETHICS AT THE END OF LIFE > Flashcards

19. ETHICS AT THE END OF LIFE Flashcards

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USMLE® Step 1 flashcards
1
Q
  1. What are End of life Ethics?
A
  • these are the ethics become extremely relevant when
    we are dealing with very difficult cases

EXAMPLE:
- those who have a terminal illness and are struggling
- those who want to partake in assisted Euthanasia

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2
Q
  1. Who is this?
A
  • this is Hippocrates
  • the Hippocratic Oath was first written by him in 400
    B.C
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3
Q
  1. What is Palliative Care?
A
  • it is care that comes into place when the patient can no
    longer be medically treated for their condition
  • they are on their way to death

THE FOCUS OF THIS CARE:
- is to reduce the severity of the symptoms
- rather than to try and provide a cure to the disease
- or to actively halt the progression of the disease

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4
Q
  1. What does the Palliative Care Approach aim to do for the patient?
A
  • it aims to improve their quality of life
  • it aims to improve the quality of their families life
  • when they are facing the problems associated with life-
    threatening illnesses
  • it aims to reduce, prevent and relieve suffering and
    pain
  • we strive to make the patient comfortable and happy
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5
Q
  1. What does the word: “Palliative” mean?
A
  • it is a Latin word
  • it means “to cloak”
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6
Q
  1. What is the relationship between Palliative Care and End of Life Care?
A
  • they are not the same

END OF LIFE CARE:
- can be included in Palliative Care

PALLIATIVE CARE:
- is much broader
- it can last for much longer
- it does not destine you to die soon
- it is the recognition that the patient has a terminal
disease
- patients can have palliative care for years

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7
Q
  1. When does Palliative Care begin?
A
  • it starts when we recognise and diagnose a patient
    with a terminal disease
  • we estimate how many years the patient has left
  • EG: 2-3 years
  • we do not expect the patient to be extremely sick and
    near death
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8
Q
  1. Look at this Case Study.
    As a doctor, what should you do?
A
  1. WE ANALYSE TO SEE WHETHER THIS IS A FUTILE CASE:
    - this is a case where the person has a less than 2%
    chance of survival
    - they cannot be treated to be cured
  2. WE HAVE TO INFORM THE CHILDREN:
    - that Mrs Smith is at the end of her life
  3. WE HAVE TO PUT MRS SMITH IN PALLIATIVE CARE:
    - to improve the quality of her life before her death
    - to relieve her pain and suffering as much as possible
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9
Q
  1. Look at this Case Study.
    What are some of the concerns of Mrs Smith’s case?
A
  1. Mrs smith failed to receive adequate pain and
    symptom management
  2. There was inadequate communication between the
    patient, her family and the clinical team
  3. The Goals of care were not discussed while Mrs Smith
    was able to communicate
  4. The family never realised the severity of Mrs Smith’s
    Condition
  5. The Junior doctors were unfamiliar with the issues
    regarding terminal patients
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10
Q
  1. What aspects do we focus on when we are looking after a patient at the end of their life?
A
  • relieving their pain
  • showing them love
  • maintaining their dignity
  • helping to keep them hopeful
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11
Q
  1. Why do we aim to relieve the patients from pain during the End of their life?
A
  • it improves the quality of life for terminal patients
  • it is a priority for healthcare professionals
  • it makes breathing easier
  • it lets the patients relax and sleep more
  • it reduces emotional pain
  • helps the patients to make the most of their final days
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12
Q
  1. What makes treating pain so complex and multidisciplinary?
A
  • the patient feels unpleasant sensations
  • the patient has many unpleasant experiences
  • the patient is in fear
  • the patient is suffering
  • the patient understands their pain in a subjective
    manner
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13
Q
  1. Look at this case.
    Can you legally justify his actions and how?
A
  • there is no way of justifying this
  • the doctor is not in any means trying to help his patient
  • his wife is not suffering in any medical way
  • he is trying to kill his wife
  • this is an illegal murder
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14
Q
  1. What are some acute symptoms of Arsenic Poisoning?
A
  • headache
  • severe diarrhoea
  • vomiting
  • vomiting with blood present
  • pain in the abdomen
  • metal or garlic taste in the mouth
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15
Q
  1. What are some chronic symptoms of Arsenic Poisoning?
A
  • partial paralysis
  • numbness in the hands and feet
  • blindness
  • seizures
  • skin thickness
  • skin discolouration
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16
Q
  1. Look at this case.
    What can be observed?
A
  • Potassium Chloride can kill the patient
  • it is not a pain killer
  • the doctor is doing this out of compassion or love
  • but it can still be seen as a criminal action
  • he tried to help
  • but the court classified this as an attempted murder
17
Q
  1. Look at this case.
    What can be observed?
A
  • Substantial brain damage can lead to the end of
    consciousness
  • this can remove an individual’s personhood
  • there were multiple doctors who decided to put the
    patient on a respirator
  • this is an example of Passive Euthanasia
18
Q
  1. Look at this case.
    What can be observed?
A
  • this Doctor is also known as Dr Death
  • these doctors believe that they are helping their
    patient’s in this way
  • they can be seen as abusing their power
  • this is an example of Assisted Suicide
19
Q
  1. What are the different kinds of ways in which an individual can kill themselves?
A
  • Suicide
  • Assisted Suicide
  • Euthanasia
  • Passive Euthanasia
  • Active Euthanasia
20
Q
  1. Define Euthanasia (E).
A
  • this is a deliberate act
  • it is undertaken by one person with the intension of
    ending the life of another person
  • it aims to relieve the suffering of that person
21
Q
  1. What is the derivative of the term: “Euthanasia”.
A
  • it comes from the greek term “Euthanatos”
  • it means a good death
22
Q
  1. Define Active Euthanasia (AE).
A
  • the Physician will take an active and deliberate step
  • to end the life of the patient

EXAMPLE:
- this can be done by injecting Potassium Chloride into
the patient
- this is a lethal medication
- it does not act as a Pain Killer
(unlike Morphine)

23
Q
  1. Define Passive Euthanasia (PE).
A
  • it is intentionally letting a patient die
  • by withholding artificial life support

EXAMPLE:
- refusal to give specific life-saving medication to the
patient

EXAMPLE:
- switching off the patient’s ventilator
- not giving the patient their feeding tube

EXAMPLE:
- not performing a surgery that would save the patient’s
life

24
Q
  1. When it comes to Passive Euthanasia, what distinction do some ethicists make?
A
  • they distinguish between withholding life support
  • and withdrawing life support

WITHDRAWING LIFE SUPPORT:
- this is when the patient was on life support
- but was then removed from it

WITHHOLDING LIFE SUPPORT:
- treatment was not given in the first place

25
Q
  1. Are suicides usually Active or Passive?
A
  • they are usually active
  • it can be passive suicide when patient’s refuse life-
    saving treatment
  • these patient’s have to have the full capacity to make
    this decision
  • this is stated in the Mental Capacity Act of 2005
26
Q
  1. What does the Human Rights Act of 1998 State?
A
  • it protects the right to freedom from inhuman and
    degrading treatments
  • it protects the right to private and family life
27
Q
  1. What does the Suicide Act of 1961 state?
A
  • Suicide is not unlawful
28
Q
  1. Define Suicide.
A
  • it is the act of intentionally ending one’s own life
  • it requires the victim to take his or her own life
29
Q
  1. Define Assisted Suicide (AS).
A
  • this is also known as Physician Assisted Suicide (PAS)
  • it is the suicide undertaken with the aid of another
    person
  • it is a suicide that is assisted by a physician or another
    healthcare provider
30
Q
  1. What are some examples of Assisted Suicide (AS)?
A
  1. THE PROVISION OF DRUGS
    • to be taken by the patient
    • in quantities that would enable suicide
  2. TO PROVIDE A COMPUTER OPERATED SYSTEM
    • that allows the individual to direct a computer that is
      connected to a medical apparatus
    • this would allow them to administer lethal quantities
      of drugs
31
Q
  1. Define Voluntary Euthanasia.
A
  • this is the behaviour that comes from the patient
  • it has caused the patient’d death at the request of the
    patient
32
Q
  1. Define Non-Voluntary Euthanasia.
A
  • this is when the patient is unconscious
  • or unable to make a meaningful choice between living
    and dying
  • an appropriate person makes the decision on their
    behalf

IT CAN ALSO BE DEFINED AS:
- behaviour from an appropriate individual or doctor
- which causes euthanasia without the consent or
objection of the patient
- the patient has made no request or given any consent
to be euthanised

33
Q
  1. What are some examples of individuals who cannot make a meaningful decision between living and dying?
A
  • very young babies
  • people with extremely low intelligence

MED 105- MEDICAL ETHICS (36 decks)

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