Bioethics Week 13- Death and Dying

Question 1

What is the history of death and dying?

Answer 1

1. Human mortality is known from antiquity

2. Medicine looked at illness as something to be defeated, and death is an example of failure

Question 2

What are two current major changes in death and dying?

Answer 2

1. Modern hospice care

2. Understanding physician role/responsibility to care for the dying as well as for living

Question 3

Definition of palliative care

Answer 3

care of patients with life limiting illness with the primary goal of comfort and quality

Question 4

Definition of hospice

Answer 4

the care of a terminally ill patient

Question 5

Definition of terminally ill

Answer 5

life expectancy of less than or equal to 6 months if the disease runs it normal course

Question 6

How are palliative care, hospice, and terminally ill patients related?

Answer 6

All patients receiving hospice receive palliative care but not necessarily all patients receiving palliative care are on hospice

Question 7

What are the 4 guiding ethical principles?

Answer 7

1. Beneficence
2. Non-maleficence
3. Autonomy
4. Justice

Question 8

What determines the concept of “personhood”?

Answer 8

All aspects of a person’s life including family, past, hopes, politics, secret life, relationships, personality… etc.

Question 9

What are the 7 principles of patient-centered ELC

Answer 9

1. Focus
2. Self determination
3. Autonomy
4. Personal Beliefs
5. Informed Consent
6. Balance
7. Notice

Question 10

What does focus concentrate on?

Answer 10

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

Question 11

What should a physician avoid with the “focus” principle?

Answer 11

physicians may offer disease-directed treatments to placate their own personal discomfort with a dying patient

Question 12

What does self-determination concentrate on?

Answer 12

how individuals tolerate pain and suffering

• only the patient can determine whether suffering is present
• physicians should prescribe comforting treatments to alleviate suffering

Question 13

What are the various forms of suffering?

Answer 13

pain, symptom relief, emotional angst

Question 14

What does autonomy concentrate on?

Answer 14

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

Question 15

What does personal beliefs concentrate on?

Answer 15

patient should feel empowered to make decisions based on their values and beliefs without fear
*law and policy shouldn’t interfere

Question 16

What does informed consent concentrate on?

Answer 16

patient must have comprehensive, candid information in order to make valid decisions and give consent

Question 17

What does the acronym “BRAIN” stand for?

Answer 17

Benefits, Risks, Alternatives, their own Insight, and consequences of doing Nothing

Question 18

When does a patient use the acronym “BRAIN”?

Answer 18

with informed consent principle and before giving consent to procedures and treatment

Question 19

What does balance focus on?

Answer 19

patient should make decisions based on their own assessment of balance between quantity and quality of life

Question 20

What does notice focus on?

Answer 20

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

Question 21

How to tell if someone is going to die?

Answer 21

weakness, fatigue, functional decline
diminished blood perfusion- cool clammy skin
“death rattles” in upper airway

Question 22

What are some performance measures used to know if someone is going to die?

Answer 22

KPS- Karnofsky performance scale
NYHA- New York Health Association heart failure classification
FAST- Functional Assessment of Staging scale
Dependence on ADLs

Question 23

How to respond to impending death

Answer 23

communicate with patient, family, and care team

Question 24

Who is on the Care Team for a patient who is nearing death?

Answer 24

palliative care

hospice