Chapter 9: Ethical Issues in End-of-Life Nursing Care Flashcards
Exam 3
Responsibility of Nurses Toward Suffering Patients:
Interpret patients’ suffering.
Minimize pain or distress.
Be mindful of need for compassion.
Console suffering patients.
Responsibility of Nurses Toward Suffering Patients:
Principles of mercy
Duty not to cause further suffering
Duty to act to end existing suffering
The Definition of Death: Uniform Determination of Death Act of 1981 (UDDA) addresses two types:
Whole-brain death
Cardiopulmonary death
The Definition of Death: Uniform Determination of Death Act of 1981 (UDDA) addresses two types:
Whole-brain death:
Mechanical ventilation required to breathe
The Definition of Death: Uniform Determination of Death Act of 1981 (UDDA) addresses two types:
Cardiopulmonary death:
Irreversible cessation of respiratory and circulatory processes
The Definition of Death:
Higher-brain death: What state is it?
Persistent vegetative state- some brainstem functions intact
The Definition of Death:
Higher-brain death: What is not required?
Mechanical ventilation not required
The Ideal Death:
Death anxiety & avoidance: Dread of death..
Dread of death in the unconscious
The Ideal Death:
Death anxiety & avoidance: What should you recognize?
Recognize the influence of death anxiety.
The Ideal Death:
Death anxiety & avoidance: Yalom (1980)
individuals avoid death through immortality projects and dependence on a rescuer
The Ideal Death: How to support a good death?
Focus on illness trajectory and palliative care.
The Ideal Death: How to support a good death:
What does supporting good death do?
Minimizes suffering and promotes human dignity
The Ideal Death:
Support good death: How does it vary?
Varies from person to person
The Ideal Death:
Support ideal death how?
Support imaginative dramatic rehearsal.
Reconstruct the ideal death scenario.
Advance Directives:
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
Advance Directives:
Living Will: What is it?
A legal document with medical instructions for specific situations, not just end-of-life
Advance Directives:
Health Care Proxy
Another term for surrogate decision-maker
Advance Directives:
Medical Orders for Life-Sustaining Treatments (MOLST):
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
Advance Directives: How should advanced directives be available? What does this mean?
Must be physically available to healthcare providers
Patients should bring with them to hospital, avoid keeping in safes/banks
Advance Directives:
Nurses Role in Advanced Directive Planning:
Encourage honest discussions with patients and family
Use therapeutic communication
Educate re: written directive options
Medical Futility
Medical futility is an unacceptable risk of harm for a poor chance of achieving any therapeutic benefit (the risks outweigh the benefits)
What does Medical Futility relate to?
Relates to responsibility to benefit person as a whole
Palliative Care:
Palliative Goals: What are they?
Relieve pain and suffering.
Palliative Care:
Palliative Goals: What do they help with?
Help maintain dignity
Palliative Care:
What is the primary responsibility of nurses in Palliative Care?
Alleviation of pain/suffering
Makes all palliative care an ethical concern
Hospice: Is what kind of death? What kind of treatment is this?
Hospice- a good death. No longer pursuing curative treatments
The Right to Die and the Right to Refuse Treatment:
How should nurses be with a patient refusing treatment? What should the nurse consider?
Support the patient’s right to refuse treatment.
Consider the perceived burden of illness.
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?
Ensure the decision is truly autonomous.
The Right to Die and the Right to Refuse Treatment:
Withholding and Withdrawing Life-Sustaining Treatment: What is an example?
Exemplar case: Terri Schiavo
Substituted judgment standard
Rule of Double Effect:
Conditions in which an act causing good and evil is permitted means?
- Act is not in itself wrong
- Nurse intends good and not the harm
- The situation is proportionately grave, and the nurse takes care to mitigate harm
Rule of Double Effect:
Nursing Considerations:
What should nurses be aware of?
What should nurses be relieving?
How should nurses evaluate cases?
Be aware of the potential for hastening death.
Relieve pain and other symptoms.
Evaluate each circumstance individually.
Terminal Sedation:
When is it used?
Used only in the last stages of life
Terminal Sedation: What does it require?
Requires understanding of ethical implications
Terminal Sedation: How is it done?
Sedation is administered to render a person unconscious as life-supporting technologies are withheld
Euthanasia: What is it?
the act of assisting people with their death in order to end their suffering, but without the backing of a controlling legal authority
Euthanasia:
Can be ____or _____.
Can be autonomous or paternalistic
Euthanasia: What are the types?
Active euthanasia
Passive euthanasia
Voluntary euthanasia
Nonvoluntary euthanasia
Involuntary euthanasia
Active euthanasia
Intentional act of causing immediate death
Passive euthanasia
Intentional withholding of life-sustaining treatments
Voluntary euthanasia
Patient authorization of euthanasia
Nonvoluntary euthanasia
Occurs with persons unable to consent
Involuntary euthanasia
Occurs when consent is possible but not sought
Physician-Assisted Death aka?
AKA Medically-aided death-
Physician-Assisted Death AKA Medically-aided death-
What is required for it?
Individuals must have a terminal illness + a prognosis of six months or less to live.
Physician-Assisted Death: What cannot occur?
Physicians cannot be prosecuted for prescribing medications to hasten death.
Physician-Assisted Death: States that it is allowed?
Allowable by law in: Oregon, Washington, Montana, Vermont, California, Colorado, Washington D.C., Hawai’i, New Jersey, Maine, New Mexico
Which state has the death with dignity act?
Death with Dignity Act in Oregon
Oregon Nurses’ Association has guidelines for nurses who care for patients choosing physician-assisted death
Nurses may NOT
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
Types of Suicide
Physician-Assisted:
Rational Suicide
Irrational Suicide
Types of Suicide:
Physician-Assisted: What is it?
Physician-Assisted: Taking own life with a lethal dose of physician-ordered medication
Types of Suicide:
Physician-Assisted: How is it being viewed?
Increasing acceptance
Physician-Assisted: What three conditions must be met:
Know that person intends to end life
Make means available to the person
Person must then end life
Types of Suicide:
Rational Suicide: How is it categorized?
Categorized as voluntary, active euthanasia
Types of Suicide:
Rational Suicide: Someone contemplating this:
Has a realistic assessment of circumstances
Is free from severe emotional distress
Has motivation understandable to most uninvolved people
Types of Suicide:
Irrational Suicide
Irrational thinking accompanying psychiatric disorder and that accompanying suicidal ideation and between state and trait cognitive dysfunctions
Care for Dying Patients:
Three major themes (Maeve, 1998)
Tempering involvement
Doing the right/good thing
Cleaning up
Care for Dying Patients: What must be done?
Be honest with patients.
Inform on advance directives and treatment.
Relate to patients’ fear of death.
Alleviate pain and suffering.
