Common ethical issues

Question 1

What is curing?

Answer 1

The alleiation of symptoms of the termination or suppresion of a disease process

Question 2

What is healing?

Answer 2

A gradual awakening to a deeper sense of self in a way that effects profound change

Question 3

Why is end of life care talked about more now?

Answer 3

Technology

Question 4

What are the four paradigms of dying in our culture today?

Answer 4

1. Death is a natural part of life
2. The medicalizatinon of dying
3. Palliative medicine/hospice
4. Death on demand

Question 5

What are the four conclusions of the SUPPORT study?

Answer 5

1. poor symptom management
2. Inconsistent with patient preferences and values
3. Problematic communication and decision making
4. Life-prolonging, intensive treatments vs palliative care

Question 6

What is the first question to ask for a patient at the end of life?

Answer 6

What are their goals

Question 7

Is technology neutral or the cause of end of life issues?

Answer 7

Neutral–it’s how we use it

Question 8

When evaluating modalities of treatment, what five things must be assessed?

Answer 8

1. Risks
2. benefits
3. burdens
4. probability
5. harm

Question 9

What is the recommended method of feeding patients with end stage dementia?

Answer 9

oral assistance

Question 10

What are the steps of the “goals of care” conversation?

Answer 10

1. Review situation
2. Asscess decision maker’s understanding
3. Establish goals
4. Present options
5. Weigh risks/benefits
6. Measure effects of decision on loved ones
7. Off additional resources
8. Provide ongoing support

Question 11

What does 6-6-6-6 thing mean?

Answer 11

What was person like 6 month, weeks, days, hours ago

Question 12

What are the three questions that shold be asked when withholding/withdrawing resuscitation?

Answer 12

1. Avoid death?
2. Prolong life?
3. Define success

Question 13

What is the difference between euthanasia and physician assisted suicide?

Answer 13

Euthanasia = dr kills
Assisted = dr supplies means

Question 14

Are euthanasia or physician assissted suicide legal in the U.S.?

Answer 14

Euthanasia, no

PAS = in some states

Question 15

What is non-voluntary euthanasia?

Answer 15

Pt did not consent or request death

Question 16

What is passive euthanasia?

Answer 16

Erroneuous term, that means to let pt die

Question 17

What are the ethical cons of euthanasia in terms of social justice?

Answer 17

May devalue marginalized

Question 18

What are the three established practices of euthanasia?

Answer 18

1. Voluntary, informed refusal of treatment by pt
2. Withhold/withdraw based on best interests
3. Palliative and hospice care

Question 19

What are the four controversial issues in terms of euthanasia?

Answer 19

1. Voluntarily stopping intake
2. Palliative sedation
3. PAS
4. Pt/surrogate demand futile therapies

Question 20

Does the use of opioids hasten death?

Answer 20

No–breathing happens long after earlier symptoms develop

Question 21

What are the four principles of double effect?

Answer 21

1. Nature of the act
2. Agent’s intentions
3. Distinction between means and effects
4. Proportionality b/t good effect and the bad effect

Question 22

What does the “nature of the act mean” in terms of the principle of double effect?

Answer 22

The act has to be good or at least morally neutral

Question 23

What does the “agent’s intentions” mean in terms of the principle of double effect?

Answer 23

Agent must intend only good. Bad effects can be foreseen and tolerated, but NOT INTENDED.

Question 24

What does the “distiction between means and effects” mean in terms of the principle of double effect?

Answer 24

bad effect must not be a means to a good effect

Question 25

What does the "proportionality between the goood effect and the bad effect "mean in terms of the principle of double effect?

Answer 25

Good > Bad

Question 26

What is the definition of medical futility?

Answer 26

Unacceptable liklihood of achieving a therapeutic benefit for the pt

Question 27

What is the quantitative component to medical futility?

Answer 27

How many/ to what degree do we have to fail to call futile

Question 28

What is the qualitative component to medical futility?

Answer 28

PATIENT must have capacity to appreciate benefit of the Rx

Question 29

What is the effectiveness component to medical futility?

Answer 29

Assessment of the capacity of the treatment to be effective

Question 30

What is the burden component to medical futility?

Answer 30

Assessment of costs, discomforts, pain, etc to pt

Question 31

What are the three major legal cases involved in medical futility?

Answer 31

1. Quinlan 2. Cruzan 3. Schiavo

Question 32

What did the quinlan case prompt?

Answer 32

Formation of ethical comittees

Question 33

What did the cruzan case prompt?

Answer 33

Led to patient self-determination act / advanced directive

Question 34

What was the first supreme court case of the right to die?

Answer 34

Cruzan

Question 35

What did the Schiavo case prompt?

Answer 35

Enhanced communication about advanced directives

Question 36

What is the law in terms of ethics?

Answer 36

The minimal ethic; what we must/must not do

Question 37

If a patient does not have decision making capacity, do they still have the right to decline or consent to medical treatment?

Answer 37

Yes

Question 38

What are the four aspects of the "circle of decision makers"

Answer 38

Self Direction Best interest Court

Question 39

What defines hospice?

Answer 39

The medicare hospice benefit

Question 40

What are the qualifications for hospice?

Answer 40

Qualified for medicare | Less than 6 months to live (according to two physicians)

Question 41

What is the unacceptable phrase to say to a terminal pt?

Answer 41

"There's nothing more we can do"