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Nurs 448 (Ethics) > Chapter 9: Ethical Issues in End-of-Life Nursing Care > Flashcards

Chapter 9: Ethical Issues in End-of-Life Nursing Care Flashcards

Exam 3

1
Q

Responsibility of Nurses Toward Suffering Patients:

A

Interpret patients’ suffering.

Minimize pain or distress.

Be mindful of need for compassion.

Console suffering patients.

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2
Q

Responsibility of Nurses Toward Suffering Patients:

Principles of mercy

A

Duty not to cause further suffering

Duty to act to end existing suffering

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3
Q

The Definition of Death: Uniform Determination of Death Act of 1981 (UDDA) addresses two types:

A

Whole-brain death

Cardiopulmonary death

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4
Q

The Definition of Death: Uniform Determination of Death Act of 1981 (UDDA) addresses two types:

Whole-brain death:

A

Mechanical ventilation required to breathe

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5
Q

The Definition of Death: Uniform Determination of Death Act of 1981 (UDDA) addresses two types:

Cardiopulmonary death:

A

Irreversible cessation of respiratory and circulatory processes

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6
Q

The Definition of Death:

Higher-brain death: What state is it?

A

Persistent vegetative state- some brainstem functions intact

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7
Q

The Definition of Death:

Higher-brain death: What is not required?

A

Mechanical ventilation not required

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8
Q

The Ideal Death:

Death anxiety & avoidance: Dread of death..

A

Dread of death in the unconscious

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9
Q

The Ideal Death:

Death anxiety & avoidance: What should you recognize?

A

Recognize the influence of death anxiety.

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10
Q

The Ideal Death:

Death anxiety & avoidance: Yalom (1980)

A

individuals avoid death through immortality projects and dependence on a rescuer

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11
Q

The Ideal Death: How to support a good death?

A

Focus on illness trajectory and palliative care.

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12
Q

The Ideal Death: How to support a good death:

What does supporting good death do?

A

Minimizes suffering and promotes human dignity

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13
Q

The Ideal Death:

Support good death: How does it vary?

A

Varies from person to person

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14
Q

The Ideal Death:

Support ideal death how?

A

Support imaginative dramatic rehearsal.

Reconstruct the ideal death scenario.

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15
Q

Advance Directives:

A

Written expression of wishes about medical care, whereas a conventional will/attorney only considers property

a general term encompassing all types of written wishes about medical care

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16
Q

Advance Directives:

Living Will: What is it?

A

A legal document with medical instructions for specific situations, not just end-of-life

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17
Q

Advance Directives:

Health Care Proxy

A

Another term for surrogate decision-maker

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18
Q

Advance Directives:

Medical Orders for Life-Sustaining Treatments (MOLST):

A

a set of medical orders for patients with advanced illness who might die within 1-2 years; require long-term care services; or wish to avoid and/or receive specific life-sustaining treatments now

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19
Q

Advance Directives: How should advanced directives be available? What does this mean?

A

Must be physically available to healthcare providers

Patients should bring with them to hospital, avoid keeping in safes/banks

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20
Q

Advance Directives:

Nurses Role in Advanced Directive Planning:

A

Encourage honest discussions with patients and family

Use therapeutic communication

Educate re: written directive options

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21
Q

Medical Futility

A

Medical futility is an unacceptable risk of harm for a poor chance of achieving any therapeutic benefit (the risks outweigh the benefits)

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22
Q

What does Medical Futility relate to?

A

Relates to responsibility to benefit person as a whole

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23
Q

Palliative Care:

Palliative Goals: What are they?

A

Relieve pain and suffering.

24
Q

Palliative Care:

Palliative Goals: What do they help with?

A

Help maintain dignity

25
Q

Palliative Care:

What is the primary responsibility of nurses in Palliative Care?

A

Alleviation of pain/suffering

Makes all palliative care an ethical concern

26
Q

Hospice: Is what kind of death? What kind of treatment is this?

A

Hospice- a good death. No longer pursuing curative treatments

27
Q

The Right to Die and the Right to Refuse Treatment:

How should nurses be with a patient refusing treatment? What should the nurse consider?

A

Support the patient’s right to refuse treatment.

Consider the perceived burden of illness.

28
Q

The Right to Die and the Right to Refuse Treatment:

What does the nurse have to ensure about the decision to die/refuse treatment by the patient?

A

Ensure the decision is truly autonomous.

29
Q

The Right to Die and the Right to Refuse Treatment:

Withholding and Withdrawing Life-Sustaining Treatment: What is an example?

A

Exemplar case: Terri Schiavo

Substituted judgment standard

30
Q

Rule of Double Effect:

Conditions in which an act causing good and evil is permitted means?

A
  1. Act is not in itself wrong
  2. Nurse intends good and not the harm
  3. The situation is proportionately grave, and the nurse takes care to mitigate harm
31
Q

Rule of Double Effect:

Nursing Considerations:

What should nurses be aware of?

What should nurses be relieving?

How should nurses evaluate cases?

A

Be aware of the potential for hastening death.
Relieve pain and other symptoms.
Evaluate each circumstance individually.

32
Q

Terminal Sedation:

When is it used?

A

Used only in the last stages of life

33
Q

Terminal Sedation: What does it require?

A

Requires understanding of ethical implications

34
Q

Terminal Sedation: How is it done?

A

Sedation is administered to render a person unconscious as life-supporting technologies are withheld

35
Q

Euthanasia: What is it?

A

the act of assisting people with their death in order to end their suffering, but without the backing of a controlling legal authority

36
Q

Euthanasia:

Can be ____or _____.

A

Can be autonomous or paternalistic

37
Q

Euthanasia: What are the types?

A

Active euthanasia

Passive euthanasia

Voluntary euthanasia

Nonvoluntary euthanasia

Involuntary euthanasia

38
Q

Active euthanasia

A

Intentional act of causing immediate death

39
Q

Passive euthanasia

A

Intentional withholding of life-sustaining treatments

40
Q

Voluntary euthanasia

A

Patient authorization of euthanasia

41
Q

Nonvoluntary euthanasia

A

Occurs with persons unable to consent

42
Q

Involuntary euthanasia

A

Occurs when consent is possible but not sought

43
Q

Physician-Assisted Death aka?

A

AKA Medically-aided death-

44
Q

Physician-Assisted Death AKA Medically-aided death-

What is required for it?

A

Individuals must have a terminal illness + a prognosis of six months or less to live.

45
Q

Physician-Assisted Death: What cannot occur?

A

Physicians cannot be prosecuted for prescribing medications to hasten death.

46
Q

Physician-Assisted Death: States that it is allowed?

A

Allowable by law in: Oregon, Washington, Montana, Vermont, California, Colorado, Washington D.C., Hawai’i, New Jersey, Maine, New Mexico

47
Q

Which state has the death with dignity act?

A

Death with Dignity Act in Oregon

48
Q

Oregon Nurses’ Association has guidelines for nurses who care for patients choosing physician-assisted death
Nurses may NOT

A

Administer the medication, the patient must do so themselves

Breach confidentiality- Duty to Disclose waived

Make judgmental statements about the patient

Refuse to render care

49
Q

Types of Suicide

A

Physician-Assisted:

Rational Suicide

Irrational Suicide

50
Q

Types of Suicide:

Physician-Assisted: What is it?

A

Physician-Assisted: Taking own life with a lethal dose of physician-ordered medication

51
Q

Types of Suicide:

Physician-Assisted: How is it being viewed?

A

Increasing acceptance

52
Q

Physician-Assisted: What three conditions must be met:

A

Know that person intends to end life
Make means available to the person
Person must then end life

53
Q

Types of Suicide:

Rational Suicide: How is it categorized?

A

Categorized as voluntary, active euthanasia

54
Q

Types of Suicide:

Rational Suicide: Someone contemplating this:

A

Has a realistic assessment of circumstances

Is free from severe emotional distress

Has motivation understandable to most uninvolved people

55
Q

Types of Suicide:

Irrational Suicide

A

Irrational thinking accompanying psychiatric disorder and that accompanying suicidal ideation and between state and trait cognitive dysfunctions

56
Q

Care for Dying Patients:

Three major themes (Maeve, 1998)

A

Tempering involvement
Doing the right/good thing
Cleaning up

57
Q

Care for Dying Patients: What must be done?

A

Be honest with patients.

Inform on advance directives and treatment.

Relate to patients’ fear of death.

Alleviate pain and suffering.

Nurs 448 (Ethics) (13 decks)

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