Advanced care for life

Question 1

What is Ethics?

Answer 1

Ethics is… the study of what we may classify as a good or a bad action and provides a framework for us to weigh that action.

Question 2

What are the 4 different branches of ethics?

Answer 2

• Consequentialist - the RIGHT response is related to the outcome
• Deontological - The RIGHT approach is fulfilling duties and responsibilities
• Virtue ethics - the RIGHT response is the one made with moral character
• Principlism - often used in healthcare settings

Question 3

What are the four principlesn- healthcare ethics?

Answer 3

Consequentialist (outcomes) 
Beneficence (do good) 
Non Maleficence (do no harm) 

Deontological (rights and responsibilities)

Respect for Autonomy (self determination) - The patient as the principal decision maker

Distributive Justice - “Fairness” and balancing the needs of individuals with those of society

Question 4

What is the mental capacity act (2005)?

Answer 4

Provides the legal framework for the care and treatment of those who may NOT be able to make decisions for themselves.

Determines:
Who makes those decisions
How those decisions should be made

Underlying philosophy is to ensure that any decision made, is made in “best interests”.

Question 5

What are the 5 Key principles?

Answer 5

5 Key principles:

Must assume a person has capacity, unless can establish incapacity

Individuals should be supported where possible to make own decisions - capacity may vary, at different times, for different reasons

Right to make eccentric/unwise decisions

If lack of capacity established, someone must decide in ‘best interests’ of the patient

Rights and freedoms must be restricted as little as possible

Question 6

What is “best interests”?

Answer 6

Decisions made on behalf of someone who lacks capacity must be in their “best interests”

Best guess as to what they would choose if they were able to

x Not what you would chose or think is best

Decision and time specific

Is the process we use to decide what medicines to give to patients who cannot consent/withhold consent themselves.
Is how we can ethically and legally give medicines covertly.

Question 7

Who makes best interests decisions?

Answer 7

Patient while they have capacity

Healthcare professional when patient lacks capacity:
NOT family/NOK (next of kin) - has no legal standing in decision making
But certainly: Taking into account family members knowledge of patients wishes and preferences
If no “advocate” for the patient, then appoint an IMCA for important decisions (life changing/threatening treatments, changes in place of residence)
IMCA - Equivalent of family member to help make a good decision

LPA for health (if appointed)

Question 8

What is the Advance Decision to Refuse Treatment - ADRT?

Answer 8

A decision relating to a specific treatment in specific circumstances
- Relates to refusal (NOT request) for treatment
- Can be written or verbal
- Must be written, signed and witnessed if it includes a refusal of life sustaining treatment
- Will come into effect only when the individual has lost capacity to give or refuse consent
- Is legally binding
- Should be shared with family and MDT
- Must be valid and applicable
o Consistent with patient’s behaviour
o Not trumped by LPA

Question 9

Ethical analysys of CPR

Answer 9

Beneficence - restart cardiac and respiratory function

Maleficence - brutal, rib #, anoxic brain injury, ventilation, poor survival and discharge rates even after successful CPR

Justice - not in interests of distributive justice to offer if “futile” - shouldn’t offer CPR to patients who have advanced disease because when they die of their disease, CPR won’t be helpful - CPR not a valid treatment and shouldn’t be offered in this case

Autonomy - consent for CRP, DNACPR needs to be informed. Patient is decision maker, not family. Patients is not offered decision regarding treatment where it is deemed futile, but entitled to second opinion on the futility issue.