Bioethics Week 13- Death and Dying Flashcards
What is the history of death and dying?
- Human mortality is known from antiquity
2. Medicine looked at illness as something to be defeated, and death is an example of failure
What are two current major changes in death and dying?
- Modern hospice care
2. Understanding physician role/responsibility to care for the dying as well as for living
Definition of palliative care
care of patients with life limiting illness with the primary goal of comfort and quality
Definition of hospice
the care of a terminally ill patient
Definition of terminally ill
life expectancy of less than or equal to 6 months if the disease runs it normal course
How are palliative care, hospice, and terminally ill patients related?
All patients receiving hospice receive palliative care but not necessarily all patients receiving palliative care are on hospice
What are the 4 guiding ethical principles?
- Beneficence
- Non-maleficence
- Autonomy
- Justice
What determines the concept of “personhood”?
All aspects of a person’s life including family, past, hopes, politics, secret life, relationships, personality… etc.
What are the 7 principles of patient-centered ELC
- Focus
- Self determination
- Autonomy
- Personal Beliefs
- Informed Consent
- Balance
- Notice
What does focus concentrate on?
end-of-life care should focus on patient’s life and current experience
- Confusion on view of death- failure of treatment vs natural dying process
- Physician response to death: withdrawal or avoidance
What should a physician avoid with the “focus” principle?
physicians may offer disease-directed treatments to placate their own personal discomfort with a dying patient
What does self-determination concentrate on?
how individuals tolerate pain and suffering
- only the patient can determine whether suffering is present
- physicians should prescribe comforting treatments to alleviate suffering
What are the various forms of suffering?
pain, symptom relief, emotional angst
What does autonomy concentrate on?
Decisions about end-of-life care begin and end with the autonomous patient
“who should decide” “the patient decides”
- even if patient is no longer capable of decision making, their own wishes still should be represented
What does personal beliefs concentrate on?
patient should feel empowered to make decisions based on their values and beliefs without fear
*law and policy shouldn’t interfere
What does informed consent concentrate on?
patient must have comprehensive, candid information in order to make valid decisions and give consent
What does the acronym “BRAIN” stand for?
Benefits, Risks, Alternatives, their own Insight, and consequences of doing Nothing
When does a patient use the acronym “BRAIN”?
with informed consent principle and before giving consent to procedures and treatment
What does balance focus on?
patient should make decisions based on their own assessment of balance between quantity and quality of life
What does notice focus on?
patient must have early, forthright, and complete notice of institutional and personal policies and beliefs that could impact their wishes
-physicians need to be clear about end-of-life choices
How to tell if someone is going to die?
weakness, fatigue, functional decline
diminished blood perfusion- cool clammy skin
“death rattles” in upper airway
What are some performance measures used to know if someone is going to die?
KPS- Karnofsky performance scale
NYHA- New York Health Association heart failure classification
FAST- Functional Assessment of Staging scale
Dependence on ADLs
How to respond to impending death
communicate with patient, family, and care team
Who is on the Care Team for a patient who is nearing death?
palliative care
hospice
