8: End of Life Ethics ✅ Flashcards
Hippocratic Oath quote
“I will give no deadly medicine to any one if asked, nor suggest any such counsel”
Palliative care
“Medical care that concentrates on reducing the severity of symptoms rather trying to provide a cure or halt the progression of the disease” —HMS
“An approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering” —WHO
Palliative care vs End-of-life care
Palliative is broader and can last longer
Euthanasia
Act undertaken by one person with the intention of ending the life of another person to relieve the person’s suffering
“Easy and good death”
Active euthanasia
Physician takes an active step to end the patients life
E.g. By injecting potassium chloride into the patient
Passive Euthanasia
Intentionally letting a person die by withholding artificial life support such as a ventilator or feeding tube
e.g. not giving medication or performing a surgery that would save the patients life
Acts regarding Active and Passive suicide
Mental Capacity Act (2005): states that patients with capacity can refuse life-saving treatment.
Human Rights Act (1998): protects the right to freedom from inhuman and degrading treatment and the right to private and family life.
The Suicide Act (1961): states that suicide is not unlawful.
Suicide
Act of intentionally ending ones life
Assisted suicide
Suicide undertaken with the aid of another person
Often physician-assisted suicide
-where they are helped by a medical profession
Voluntary Euthanasia
Behaviour which caused the patients death at the patients request
Non-Voluntary euthanasia
Occurs when the person is unconscious or otherwise unable to make a meaningful choice between living and dying, and an appropriate persona takes the decision on their behalf
-behaviour which causes euthanasia without the consent or objection of the patient
Arguments for euthanasia
- Suicide is accepted
- Autonomy
- Beneficence
Arguments against euthanasia
- Sanctity of life
- Palliative care
- Slippery slope argument
- Killing is wrong
- Non-maleficence
- Physician integrity
Protection of the vulnerable
Terminal sedation
Palliative sedation is the practise of relieving distress in terminally ill people in the last hours before they die.
Done by special catheter designed to provide comfortable and discreet administration of ongoing medication
Doctrine of double effect
The nature of the act is not bad
At least one of the acts consequences is good and one is bad
There is sufficiently serious reason for allowing the bad consequence to occur
The bad consequence is not a means for the good consequence
The agent foresees the bad consequence but intends the good consequence
Legality of Palliative sedation
Allowed in some cases
e.g. administration of painkillers
Death tourism
Located in Dignitas
A cocktail of drugs that can cause death are available
Euthanasia: DDP in favour
Clear settled and informed wish to die
Unequivocal and consistent about dying
Process was initiated by person who died
Terminal illness
Motivation was solely by compassion
Person offering assistance has a long-standing and supportive relationship
Assistance provided was minor
Euthanasia: DPP against
Under 18
Questions about capacity
Unclear/ no clear settled an informed wish to die
Equivocal about dying
Process not initiated by person who dies
No terminal illness or severe degenerative disease
Not motivated by compassion
Evidence of persuasion, coercion or undue influence of pressure
GMC End of Life Care: guidelines
(112) Clinically assisted nutrition includes intravenous feeding, and feeding by nasogastric tube and by percutaneous endoscopic gastrostomy.
(113) Providing nutrition and hydration by tube or drip may provide symptom relief or prolong or improve the quality of the patient’s life.
(114) Nutrition and hydration provided by tube or drip are regarded in law as medical treatment, and should be treated in the same way as other medical interventions.
Key Disputes in the controversy over euthanasia
- Killing vs letting die - both end in the same outcome
- Ordinary vs extraordinary treatment -
3.Death intended vs anticipated
