5. Death and Dying Flashcards
1
Q
is the entire state of the living thing
A
Life
2
Q
may be considered as an element of human
autonomy through which a person experiences a sense of self.
A
Life
3
Q
it encompasses the value of the self
A
Life
4
Q
is a determining factor in a person’s “preconscious” standard of judgment.
A
Life
5
Q
The imaging professional should consider the following aspects of life when making determinations in ethical dilemmas:
A
- Life is the foundation of all other values of a patient.
- Life is the foundation of a patient’s rights.
- The preservation and maintenance of a good quality of life are the goals of the patient entering the health care environment.
- A patient is motivated to enter the health care environment when capabilities and potentialities are radically affected. If a patient can regain these capabilities and potentialities, quality of life is greatly improved.
- A patient, except in the most extreme circumstances, has no rational desire greater than the desire for life. Nevertheless, in extreme circumstances a desire for death may not be irrational.
6
Q
is the ideal underpinning the obligation not to take human life
A
Sanctity of human life
7
Q
Respect for the _________ entails an obligation not to infringe on an individual’s decisions regarding life and an obligation not to take
human life.
A
Sanctity of human life
8
Q
is the act of knowingly ending one’s life
A
Suicide
9
Q
The individual
must also have the intention to die
A
Suicide
10
Q
ARGUMENTS AGAINST SUICIDE
A
- Many religions forbid suicide.
- Life is the greatest good.
- Suicide causes harm to the community.
- Suicide causes harm to friends and family.
11
Q
Some find suicide unacceptable for _______ reasons —God has lent life to the individual, and therefore that life is not the individual’s to end
A
religious
12
Q
______ to the community is another argument
against suicide
A
Harm
13
Q
is the refusal of treatment by a person who knows that refusal will lead to death
A
Passive suicide
14
Q
is the taking of one’s own life through a conscious act
A
Active suicide
15
Q
REASONS FOR THE IMAGING PROFESSIONAL’S DUTY NOT TO COOPERATE WITH SUICIDE
A
- Assisting in or supplying the means to suicide is generally illegal.
- Health care providers are devoted to healing.
- Assisting in suicide is incompatible with professional obligation.
16
Q
is deliberately ending the life of another to end suffering
A
Euthanasia
17
Q
is the ending of another person’s life by withdrawing treatment
A
Passive euthanasia
18
Q
is the ending of another person’s life by an aggressive method to end suffering
A
Active euthanasia
19
Q
is present when one act leads to another and then to another at an accelerating rate
A
Slippery slope
20
Q
is the ability to grow and continue the life process.
A
Development
21
Q
is the expulsion or removal of a usually nonviable fetus
A
Abortion
22
Q
a fetus that cannot live outside the uterus at that time
A
nonviable fetus
23
Q
is the act of painlessly putting to death a person suffering from an incurable and painful disease or condition
A
Euthanasia
24
Q
The difference between the passive and active euthanasia lies in
the _____, not the _____
A
methods,
consequences
25
may be committed through the withholding of nourishment or through a decision not to perform cardiopulmonary
resuscitation (CPR) on a patient who has stopped breathing
Passive euthanasia
26
It is considered legal in
| certain instances because no one delivers a method of death. “Nothing” is done and that “nothing” leads to death
Passive euthanasia
27
is the performance of a specific act on the
| request or behalf of the patient to end life
Active euthanasia
28
The legal ramifications of euthanasia, especially active euthanasia, are tied to the act of
murder
29
Five stages of coming to terms with death (Kubler-Ross Theory):
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
30
is a person who substitutes for another, often in decision-making processes.
Surrogate
31
who act on behalf of patients and may make decisions and grant consent for them in quality-of-life judgments
Surrogate
32
are increasingly important elements in decisions regarding euthanasia
Advance directives and surrogates
33
A written explanation of the patient’s
wishes in the form of a ________ hastens the processes leading to
passive euthanasia.
living will or advance directive
34
The idea of lethal injections evokes perceptions of “______” and “______”
doctors of death,
| angels of mercy
35
________ is still generally illegal, however, and many roadblocks stand in the way of its becoming an accepted procedure.
Active euthanasia
36
encompasses essential traits that make life worth living
Quality of life
37
Factors influencing quality of life may include:
```
Biologic functions,
Intellect,
Creativity,
Emotions,
Contact with others
```
38
is one way to ensure that people’s wishes regarding
| treatment in relation to their quality of life are honored
Living will
39
identify specific
treatments to be initiated or discontinued when patients become terminally ill, are in great pain, or fi nd themselves in a life-threatening situation.
Living wills
40
If a living will is not present and the patient’s wishes are unknown, quality-of-life decisions are difficult to make.
In such situations, the _____ requirements for quality of life must be recognized.
minimal
41
The principles of ______ and _____ and ______ are critical issues in a discussion of quality of life.
beneficence,
nonmaleficence,
respect for autonomy
42
```
Problem solving can be aided by the use of the
following points (with modifications for imaging) from ________
```
Jonsen, Siegler, and Winslade
43
Many hospitals have formed ________ to help health care professionals address the ethical problems surrounding termination of treatment and related issues.
Ethics Committees
44
First, they educate the hospital, its employees, and its other constituencies.
Second, they develop policies regarding problem areas, especially
the problems of death and dying.
Third, they act as advisory consultants to health care
providers and families.
Ethics Committees
45
serve in an advisory capacity only
Ethics Committees
46
Ethics Committees recommendations are exercised with _______ in the patient’s best interest.
practical wisdom
47
is crucial for the well-being of the patient and the patient’s family.
Professional empathy
48
He established in the ______ case that “every human being of adult years and sound mind has a right to determine what shall be
done with his own body.”
Justice Benjamin Cardozo,
| 1914 Schloendorff
49
The findings of 1914 Schloendorff case also underpinned the ________ —because patients have a right to determine whether to consent to a particular treatment, they also have a right to refuse to consent to a particular treatment.
right to forgo treatment
50
The principle that competent patients have a right to forgo life-sustaining treatment was not articulated by any court until _____
1984
51
has been evidenced by the contemporaneous cessation of heart and lung function for centuries
Death
52
the ____ and ___ test of death became not only the evidence of death but also the actual definition of death.
Heart,
| Lung
53
Uniform Determination of Death Act was enacted in _____
1980
54
established two tests to determine death
Uniform Determination of Death Act of 1980
55
Uniform Determination of Death Act establishes that an individual is dead if he/she has sustained:
(1) irreversible cessation of circulatory and respiratory functions, or
(2) irreversible cessation of all functions of the entire brain, including
the brainstem
56
There is now nearly a consensus among philosophers
that the irreversible cessation of all brain function constitutes ______, whether it be measured through tests of brain function itself or tests for cardiopulmonary activity
death
57
the criterion in cases in which the use of life support systems or the potential for use of the decedent’s organs for transplant made the traditional criteria impossible or ineffi cient
newer “brain death”
58
promulgated the Uniform Determination of Death Act (UDDA) of 1980
National Conference of Commissioners on Uniform State Laws
59
UDDA
Uniform Determination of Death Act of 1980
60
recommended some procedures for the declaration of death:
- the ventilator should be removed after death is declared;
- the physician (and not the family) should make the decision to declare death;
- the physician may choose to consult with others (although the physician may choose not to) before declaring death; and
- the declaration should not be made by someone with an interest in the subsequent use of the tissue of a patient.
National Conference of Commissioners on Uniform State Laws
61
states that this determination is to be made “in accordance with accepted medical standards.”
UDDA
62
In _____, the Ad Hoc Committee for the Harvard Medical School to Examine the Definition of Brain Death proposed a new criterion to reflect the need for an alternative definition of death.
1968
63
The new criterion for an alternative definition of deaath is
irreversible coma
64
includes the following characteristics: unreceptiveness and unresponsiveness, no movement or breathing, no reflexes, and a flat electroencephalogram
irreversible coma
65
was used to describe patients who are now generally
referred to as in a persistent vegetative state (PVS), when all higher brain function is
lost
irreversible coma
66
PVS
Persistent Vegetative State
67
it differs from brain death because the brainstem continues to function and
the body is not dead.
Persistent Vegetative State (PVS)
68
Patients in a ___ may even seem to be awake but have no awareness of themselves or their environment.
PVS
69
MCS
Minimally Conscious State
70
PVS and MCS distinctions were brought to light in the case of
Terri Schiavo
71
is a condition of severely altered consciousness in which minimal but definite behavioral evidence of self-awareness or environmental awareness is demonstrated
Minimally Conscious State (MCS)
72
is the only form of life-sustaining treatment that is provided routinely without the consent of the patient, and it may be the only medical treatment of any kind that is generally initiated without an order of a physician.
CPR
73
CPR
Cardiopulmonary Resuscitation
74
Early cases that paved the way for recognition of directives include the:
1976 Karen Ann Quinlan case 11 and the 1990 Nancy Cruzan case
75
In response to the highly publicized
Quinlan case, many states adopted statutes designed to give formal recognition to some
form of written directives by patients; these directives are generally called
Living Wills
76
resulted in a Supreme Court split
decision that refused to allow life-sustaining measures to be withdrawn from a woman
in a PVS
Nancy Cruzan case
77
established in her opinion (which concurred
in the result with the majority, but differed in the reasoning) some further guidelines and
encouragement for use of durable powers of attorney
Justice Sandra Day O’Connor
78
is an advance directive that is not limited to terminal conditions
or specified treatments but instead appoints a person or persons to assume a substitute
decision-maker role in the event the patient is unable to make decisions
Durable power of attorney for health care decisions
79
is a condition that leaves the patient irreversibly comatose or will lead to death within a year
Terminal illness
80
The American Medical Association’s position on physician-assisted suicide is stated in
AMA Opinion 2.211
81
occurs when a physician facilitates a patient’s death by providing the
necessary means and/or information to enable the patient to perform the life-ending act (e.g.,
the physician provides sleeping pills and information about the lethal dose, while aware that
the patient may commit suicide.)
Physician-assisted suicide
82
is the ability to make choices
Competence
83
Courts have tried to use the traditional law of
_____ and _____ in dealing with the issue of competence regarding
decisions about life-sustaining treatment
guardianship,
| conservatorship
84
a term that focuses on the actual decision to be made
decisional capacity
85
a term that focuses on the actual status of the patient
competency
86
some courts have rejected the all-or-nothing approach and have recognized the concept of “______” rather than “_____"
decisional capacity,
| competency
87
This concept accepts that a person may have the attributes to make some simple health care
decisions and not to make other, more complex decisions.
decisional capacity
88
the most widely accepted test for determining patient competence comes from the _____ President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research.
1980
89
Competent decisions requires “to a greater or lesser degree” each of the following:
* Possession of a set of values and goals
* Ability to communicate and understand information
* Ability to reason and deliberate about one’s choice
90
allows patients to
state in advance (in addition to other treatment preferences) that in the event of terminal illness they wish to forgo life-sustaining treatment.
Living Will
91
this directive is broader than a living will
Durable Power of Attorney for Health Care Decisions
92
provides for a substitute decision maker to make health care decisions when the patient is not able
Durable Power of Attorney for Health Care Decisions
93
has traditionally been treated differently from other forms of
life-sustaining treatment.
CPR
94
DNR
Do Not Resuscitate
95
meaning that staff members would be instructed to provide resuscitation guaranteed not to be successful
“slow codes” or “pencil
| DNRs”
96
is generally provided unless a formal “do not resuscitate” (DNR) order is entered on the patient’s chart
CPR
97
DNI
Do Not Intubate
98
started a trend of statutes that formally recognize certain
| forms of written statements requesting that some types of medical care be discontinued
1976 Karen Quinlan case
99
formulated a uniform statute that could be adopted by states
Uniform Health Care Decisions Act of
| 1993
100
is a document executed by a competent person (the principal) to appoint another (an agent) to make health care decisions when the principal becomes incompetent
Durable Power of Attorney for Health Care Decisions
101
This is the concept that when no advance directive exists,
physicians and health care facilities should look to family members to make health care
decisions
Family Consent Laws
102
Generally they become effective only when a patient becomes incompetent; some require a certification of incompetence before the family is authorized to make health care decisions
Family Consent Laws
103
UHCDA
Uniform Health Care Decisions Act
104
was developed to replace the Uniform Rights of The Terminally Ill Act, state durable powers acts, and parts of the Uniform Anatomical Gifts Act.
Uniform Health Care Decisions Act (UHCDA)
105
It was approved by the National Council of Commissioners
| on Uniform State Laws in 1993 and by the American Bar Association House of Delegates in 1994
Uniform Health Care Decisions Act (UHCDA)
106
This act, for those states that choose to adopt it, takes a comprehensive approach by placing into one statute
- the living will, called the “individual instruction”;
- the durable power of attorney, called the “power of attorney for health care”;
- a family consent law; and
- some provisions involving organ donation.
Uniform Health Care Decisions Act (UHCDA)
107
individual instruction
Living Will
108
power of attorney for health care
Durable Power of Attorney for Health Care Decisions
109
Under the UHCDA, any health care decision will be made by the first available in the hierarchy:
1. The patient, if competent
2. The patient, through an individual instruction
3. An agent appointed by the patient in a written power of attorney for health care, unless a court has given this authority explicitly to a guardian
4. A guardian appointed by the court
5. A surrogate appointed orally by the patient
6. A surrogate selected from the list of family members and others who can make health care decisions on behalf of the patient
110
This court, which has narrowly defined even a competent patient's right to forgo treatment, has declared that adults who have been incompetent since birth should be treated the same as children
New York Court of Appeals
