Chapter Eight Flashcards
1
Q
When it is determined that a patient, like Evelyn, has certain medical conditions, such as diverticulitis and cancer, the first intervention is generally what?
A
Curative care
2
Q
What is curative care
A
any care given in an effort to cure or reduce a medical problem
3
Q
If the treatments provided to attempt to “cure” Evelyn will likely cause more pain and suffering, rather than a positive outcome. At that point, treatment is usually switched to what?
A
Palliative care
4
Q
What is palliative care?
A
is aimed at reducing pain and suffering as a person nears the end of his or her life
- Some patients receive palliative care from their family doctor, while others choose a hospice provider
5
Q
What facilities provide palliative care?
A
Hospice
- Most hospitals have a hospice wing or center
- Sometimes, hospice is provided in private centers outside of a hospital setting.
- Hospice employees will also make home visits or provide guidance at long-term care facilities.
6
Q
Why is hospice provided?
A
The only services offered are those that help to alleviate pain and suffering—not prolong life
7
Q
What are advance directives?
A
legally binding statements created by a patient to help that person make wishes known about end-of-life issues
8
Q
What are the four types of advance directives?
A
- do not resuscitate (DNR) orders
- living wills
- power of attorney or healthcare proxy designations
- Uniform Anatomical Gift Act, otherwise known as organ donation.
9
Q
What does an DNR order inform?
What do the measures include?
A
- informs healthcare professionals that a patient does not want extreme measures taken to save his or her life during cardiac arrest.
- These measures include cardiopulmonary resuscitation (CPR) and defibrillation.
10
Q
When are DNR orders recommended
A
recommended for patients who have a terminal illness with a prognosis of 6 months or less to live, or who are in the advanced stages of life and would prefer to die naturally
11
Q
What is needed to request a DNR order?
A
An adult must be competent to request a DNR order.
* If an adult is not considered competent or is unable to express his or her wishes, a power of attorney or healthcare proxy (described later in this section) might request the DNR order instead
12
Q
What is a living will?
A
living will is a legal document that indicates whether a patient wants to be placed on life-prolonging machines (also known as life support) should he or she be unable to communicate personal preferences
13
Q
Anyone can fill out and place a living will in his or her medical record, but it must be what?
A
notarized or signed by two witnesses to be considered legal
* Regulations on living wills vary from state to state, so it is best to obtain one from a local medical facility or consult a lawyer
14
Q
If the patient is placed on life support before the living will is discovered, then the medical team does what?
A
must start the process of withdrawing that life support
15
Q
Withdrawing treatment means what
A
means discontinuing the treatment once it has already been started
16
Q
Withholding treatment means what?
A
means not starting the treatment because the patient’s wishes are known beforehand
17
Q
Which one is legally and ethically easier: withhold life support or withdraw it?
A
withhold life support
18
Q
What is beneficence
A
promote the well-being of patients
19
Q
What happens when the patient does not have a living will, a power of attorney or healthcare proxy
A
need to work with an ethics committee and the attending physician to determine the appropriate course of action
- Having a living will provides clear guidelines as to the patient’s wishes, which can help prevent controversy
20
Q
What happen with Terri Schiavo?
A
21
Q
When competent adults are not able to make decisions themselves, they might rely on who?
A
a power of attorney and/or a healthcare proxy to make decisions for them
22
Q
What is a power of attorney?
A
is a written document that legally allows someone to make decisions on your behalf
- These decisions can be financial or health related
23
Q
What is a healthcare proxy? What else can it be called?
A
If a separate person is designated to make health decisions on your behalf, they are called a healthcare proxy (otherwise known as a medical power of attorney)
24
Q
A healthcare proxy designation is not the same as what?
A
financial power of attorney, who handles monetary and estate decisions.
- The same person can be both a financial power of attorney and a healthcare proxy, but some choose to have different individuals handle each role
25
How many people in the US are waiting for an organ?
122,000 people in the United States
26
Currently and historically, the list of those waiting continues to grow at a faster pace than donation . To change this, from a preventive standpoint two things must occur:
* First, we must change lifestyles in the United States to be healthier so that fewer people need transplants .
* Second, the plague of hepatitis C that we are seeing must be addressed and a solution found . From a donor standpoint, we need to continue to work with the public to ensure their trust in the system and hopefully thereby increase donations .
* Next, policies that prevent the aggressive transplantation of organs must be lifted, and policies that inhibit organ procurement organizations from placing more organs need to be removed or at least revised .
27
What is the uniform anatomical gift act?
* passed in 1968, allows anyone 18 years of age or older to donate body parts for the purpose of transplantation after his or her death.
* It also allows next of kin to give permission regarding the donation of body parts
28
To help simplify and organize the donation of organs, what second law was passsed?
* (National Organ Transplant Act) was passed in 1984 (American Organ Transplant Association, n.d.).
* This act created a network for registering and matching organ donor recipients.
* The Organ Procurement and Transplantation Network is a private, nonprofit organization that contracts with the federal government.
29
In an effort to increase the number of organ donations, many states have written laws about what?
that allow or require all individuals with a driver’s license to designate their organ donor status on their license
* This system reduces confusion and can provide clear evidence of a patient’s wishes
* even though most states provide driver’s licenses at 16 years of age, an organ donor must have approval from a parent or guardian until 18 years of age.
30
Historically, doctors only provided curative care when?
often up until the patient requested that treatment stop or simply passed away
* When life support systems were first introduced, they were seen as a possible new way to keep patients alive indefinitely.
31
One of the first patients to be placed on life support was who?
Karen Ann Quinlan
32
According to the Center for Disease Control, the leading cause of death is what?
heart disease then cancer (lung cancer)
33
Who is Karen Ann Quinlan?
34
What is persistent vegetative state?
that while she appeared to be awake, she did not have enough cognitive function to make voluntary movements and be aware of her surroundings
35
About 10 years later, the ethical issue of removing patients from life support would be tested again with what case?
Nancy Cruzan case
* When a patient does not have advance directives placed in his or her medical record, it is sometimes difficult for the medical community and next of kin to agree.
36
What was the case about nancy cruzan?
37
he State of Missouri, as pointed out by the U.S. Supreme Court, places a high importance on what?
the sanctity of life
* Other states emphasize the rights of patients to choose their own course of treatment, otherwise known as patient autonomy. This includes the right to choose when their life will end
38
Two states (Oregon and Washington) have already passed laws allowing what?
* terminally ill patients to obtain lethal doses of medication, and several states are considering this option (Euthanasia, n.d.).
* Oregon was the first state to pass a law related to physician- assisted death.
39
What is euthanasia?
is a term derived from Greek, meaning “the good death.”
* It refers to the intentional killing of a person to relieve his or her pain and suffering. Some simply refer to the process as “mercy killing.”
40
There are two types of euthanasia:
passive and active
41
What is passive euthanasia? Where is it legal?
When is there controversy?
* Passive euthanasia is allowing a patient to die naturally by withholding treatment, including food and water.
* It is legal in all 50 states and occurs quite often in long-term care facilities when elderly or terminally ill patients start refusing food and water as they near the end of life.
* Occasionally, it is met with controversy when a patient is on a feeding tube (e.g., the Terri Schiavo and Nancy Cruzan cases) or when a family member requests a feeding tube but the patient’s doctor does not recommend one.
42
Research conducted in this area has shown that the insertion of a feeding tube rarely prolongs the life of certain long-term illnesses like what?
dementia and Alzheimer’s disease
43
What is active euthanaisia?
* Physician-assisted death, on the other hand, is considered a form of active euthanasia.
* Active euthanasia is the intentional killing of a patient by non-natural means.
* Usually it involves a lethal injection of medication, but there are other controversial methods, including depriving patients of oxygen.
44
What is the jack kevorkian case?
45
In 1997, the U.S. Supreme Court recognized that there is no constitutional right to what?
* physician-assisted death, but noted that state legislatures could legalize it.
* This Supreme Court decision gave power to individual states
46
Oregon was the first state to legalize physician-assisted death when it passed what? What does it entail?
* the Death With Dignity Act. This act allows terminally ill patients in Oregon the right to self-administer a lethal dose of medication that is legally prescribed by a doctor.
* To be eligible, the patients must have a diagnosis of a terminal illness that will cause death within 6 months
* The request must be witnessed by two people, and the patient must be free of any mental illness, including depression
47
Proponents for the euthanaisa law argue for
* Argue for patient autonomy, or the right to make choices regarding treatment, including the method of their death.
* They also point out that legalizing physician-assisted death helps patients die in a dignified manner without the stigma associated with suicide or loss of life insurance for their survivors.
48
Washington followed suit with similar legislation of Euthanasia in 2008, called what?
Washington Death With Dignity Act. Other states have passed similar legislation, including Vermont, Colorado, California, and the District of Columbia
49
n addition, a few states have used court cases to provide immunity to patients who chose to end their own lives. For example, what case?
Baxter v. Montana (2009), the courts ruled that a patient’s right to privacy extends to the decision of terminally ill patients to end their lives with a lethal dose of medication.
50
Any active euthanasia that is not physician assisted is currently what?
illegal in all 50 states
51
What is assisted reproduction?
refers to artificial or semi-artificial methods of achieving pregnancy. Examples include artificial insemination, in vitro fertilization, and surrogacy.
52
What happens during during artifical insemination?
During artificial insemination, the woman takes drugs to increase egg production, and sperm (from her mate or a donor) is then implanted with a device in an effort to achieve pregnancy
53
What is the one of the most common methods of assisted reproduction? Explain the process
In vitro fertilization
* This process involves a woman taking drugs to stimulate egg production.
* These eggs are collected via a surgical procedure, combined with her mate’s sperm (or a sperm donor’s), and then reinserted into the uterus.
* Generally, several eggs are used in the hope that at least one of them will develop into a surviving embryo.
54
While artificial insemination and in vitro fertilization involve having the woman carry the baby herself, surrogacy is what?
involves having another woman carry the baby from conception to delivery.
55
Assisted reproduction options are most often used by couples who have been what?
unable to con- ceive or carry a baby to term, or by same-sex couples who wish to have children with a genetic link to one of the parents.
56
What are some ethical issues can arise from assisted reproduction?
Fertility treatments generally come at a high price and are not always covered by insurance policies.
* This cost reduces the options for couples with limited income who are unable to conceive naturally.
In addition, fertility treatments often use a third party—a sperm or egg donor, or even a surrogate mother—who gives up parental rights at the time of donation.
During artificial insemination, the sperm donor might request to remain anonymous to avoid an expectation of support in the future. However, the child created from such a union might have a compelling interest to know more about his or her anonymous parent.
57
In vitro fertilization creates more ethical issues occur when?
embryos are created and stored.
* The embryos that are not used must be kept in storage or destroyed.
* Pro-life activists (those who argue that life begins at conception, rather than birth) argue that destroying embryos is destroying life.
* Many scientists would prefer to save unwanted embryos and use them for research
58
During the in vitro fertilization process, a woman is usually transplanted with several artificially created embryos in an effort to obtain at least one viable pregnancy. This can result in?
* multiple births, usually twins but occasionally triplets or more.
* Multiple births themselves are not particularly controversial, but they can result in difficult pregnancies, premature births, and/or birth defects.
* When a multiple birth is created artificially, rather than a natural occurrence, questions about health and welfare can arise.
* Some would argue that the in vitro fertilization process is an unnecessary procedure that carries potential risk to both the mother and the offspring.
59
One of the newest forms of assisted reproduction is what? explain it
uterus transplant
* In a uterus transplant, the donated uterus is surgically placed into the recipient. If accepted by the body, the recipient will attempt to become pregnant and carry the baby to term
60
What is going on with nadya suleman?
61
Surrogacy process?
Generally, in a surrogate situation, the natural mother is unable to carry a baby to term. In these cases, the egg and sperm come from the natural mother and father, are artificially joined to create an embryo, and are then implanted into the uterus of a surrogate mother. This woman will carry the baby to delivery and relinquish all parental rights at the time of birth.
62
Questions arise as to the amount of contact a surrogate parent can or should have with the child after birth. Why?
* In the typical 9 months that a baby is carried in utero, a bond is often formed between the carrier and the fetus, making separation difficult at the time of birth.
* In addition, surrogate mothers earn monetary compensation for their services—usually a fee in addition to medical costs—which some consider unethical because it turns childbirth into a business.
63
surrogacy contracts are banned where
* the state of Arizona and in Washington DC.
* Some states void surrogacy contracts and penalize the people involved in the contract.
* Other states allow surrogacy, but with restric- tions. Before recommending any form of surrogacy, a healthcare professional should consider state laws.
64
Historically, there have been many ethical and legal issues surrounding what?
rights of an unborn child versus the rights of the mother
* As a society, we tend to place a greater emphasis on the rights of the mother, but sometimes the mother will waive those rights in favor of the unborn child or children.
65
What happens in the case of Angela carder?
In our case of Abigail and Tony, the decision was made to have an early delivery. Both Abigail and Tony agreed that they would rather accept the risks of premature infants than risk Abigail’s life. Abigail sat down to talk with her friend, the medical assistant, about their choice. Abigail told her friend that one of the options discussed was abortion—something Abigail never thought she would consider. Abigail’s friend admitted that she relied on the conscience clause at her place of work so that she did not have to help with any abortion procedures.
66
What is a conscience clause?
a federal regulatory law, protects healthcare profes- sionals from discrimination if they refuse to participate in sterilization procedures or abortions, due to religious or personal objections
67
Conscience clause included protection for who? What changed?
* The original law included protection for pharmacists and hospitals, but in January 2012, the Obama admi istration repealed the old law and replaced it with a new one.
* The new law only protects healthcare professionals who wish to avoid assisting with sterilization and abortion procedures.
* Opponents of the conscience clause state that healthcare pro- fessionals should not be able to opt out of normal job duties simply because they find them offensive.
* Ethically, it is important for healthcare professionals to research their job duties carefully before accepting a job
* Legally, a healthcare professional must tell an employer that he or she wishes to utilize the conscience clause at the time of hire.
68
An abortion is what?
is the termination of a pregnancy by removing the fetus from the uterus before it has a chance to become viable
69
In the landmark case of Roe v. Wade, the U.S. Supreme Court ruled what?
* woman’s right to privacy extends to fertility decisions.
* This means that the decision can be made to terminate a pregnancy.
* In this ruling, the states were given the right to regulate abortion, including placing limitations on when a woman can have an abortion and the need for minors to have parental consent.
* Many states limit abortions to certain instances, such as when the pregnancy puts the mother’s life at risk.
70
Individuals in favor of abortion usually argue that life does not begin until the time of birth, while individuals against abortion argue what?
that life begins at conception.
71
Another ethical issue that arises in the abortion debate is what?
debate is the rights of the biological father. When the mother wants an abortion but the father does not, or vice versa, who has the superior legal rights? Generally the courts side with the mother, as she is the one who will carry the baby to term.
