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Ethics > Critically Ill & Dying Patients > Flashcards

Critically Ill & Dying Patients Flashcards

1
Q

What are the 3 confounding issues for critically ill & dying patients?

A
  • Informed consent
  • Patient’s rights
  • Attitudes towards death & dying
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2
Q

Why is withholding and withdrawing life-support systems one of the biggest ethical problems of our time?

A
  • Available technology (can prolong, but not necessarily improve quality)
  • Long-standing medical tradition (do everything possible)
  • Often final efforts are inconsistent with Pt wishes (most Americans die alone, in pain and on some type of life support
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3
Q

What act originating in California lead to the development of advanced directives?

A
  • Natural death act 1977
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4
Q

What is an Advanced Directive? What is its purpose?

A
  • Statement (usually written) that gives directions for medical care should you become unable to speak for yourself.
  • Allows people to indicate the manner in which they want to die
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5
Q

What are the 4 types of advanced directives?

A
  • DNR (do not resuscitate) or No code
  • Living will
  • Durable power of attorney for health care (AKA health care proxy)
  • Oral advance directive
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6
Q

What is a DNR?

A

Physician’s order in Pt record indicating desire not to be revived if heart or breathing stops

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7
Q

What is a living will?

A

Direction to physicians on how to treat you if you are to develop a persistent vegetative state

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8
Q

What is a durable power of attorney/ Health Care Proxy)?

A

Designation of a surrogate decision maker (one person acts as another individual’s will)

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9
Q

What is an oral advance directive?

A

Tell physician and family what you would want in given situations (should be documented in medical record)

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10
Q

Why are advanced directives often ignored by professionals and family members?

A

Culture says lets do everything possible

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11
Q

How is a DNR obtained?

A

Physician can post per direction of patient/ guardian

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12
Q

How is a Living Will/ Durable power of attorney obtained?

A

Through department of health

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13
Q

How can an advanced directive be obtained during a hospitalization?

A
  • Federal patient self-determination act
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14
Q

Who most needs an advanced directive?

A

Young individuals who do not expect to die, and are then unexpectedly presented with their decision

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15
Q

What are 9 ways to confidently conduct yourself with a dying patient?

A
  • Call cancer a “chronic condition”/ be aware of terminology
  • Confident bedside manner
  • Self-awareness of own feelings
  • Listen actively to the patient
  • Ask, don’t assume
  • Let patient set tone of conversations
  • Touch the patient
  • Be honest, hopeful, realistic, & positive
  • Do not isolate
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16
Q

What is medically futile care?

A

Life-prolonging interventions with no chance to achieve a beneficial outcome, only prolong life.

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17
Q

What is euthanasia?

A

INTENTIONAL killing by act or omission of a dependent human being for his or her alleged benefit.

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18
Q

What is voluntary euthanasia?

A

When person who is killed has requested to be killed

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19
Q

What is non-voluntary euthanasia?

A

When person who is killed made no request and gave no consent AKA homicide

20
Q

What is involuntary euthanasia?

A

Person killed expressed wish to the contrary

21
Q

What is assisted-suicide?

A

Some provides individual with information guidance and means to take his or her own life with the intention that they will be used for this purpose

22
Q

What is physician assisted suicide?

A

Doctor helps another person kill themselves

23
Q

What is euthanasia by action?

A

Intentionally causing a person’s death by performing an action such as by giving a lethal injection

24
Q

What is euthanasia by omission?

A

Intentionally causing death by not providing necessary and ordinary care or food or water

25
Q

What is assisted suicide according to Purtilo?

A
  • Physician provides means
  • Physician necessary but not sufficient
  • Patient has active role
26
Q

What is medically administered euthanasia according to Purtilo?

A
  • Physician commits act by medical means
  • Physician necessary and sufficient
  • Patient’s illness provides context for act
27
Q

What is palliative care?

A
  • Supportive care to prevent and relieve pain and other symptoms during the dying process
  • Helps patients and loved ones deal with their own death more realistically
28
Q

What is Hospice?

A

Set up to provide palliative care and abatement of pain, either at home or in an environment that encourages dignity, but does not cure or treat intensively

29
Q

What 4 states have physician assisted suicide legalized? (via legislation? via court ruling?)

A

Via leg: OR, VT, WA

Via court: Montana

30
Q

How many states consider physician assisted suicide illegal?

A

46

31
Q

Since there are no federal laws on assisted suicide, how is it enforced?

A

Via homicide laws

32
Q

What are characteristics of individuals who got prescriptions for physician assisted suicide?

A
  • White
    • 65 yo
  • Well educated
  • Cancer diagnosis
  • Hospice enrolled
  • Health insurance
  • End of life concerns
  • Diagnosis of cancer
33
Q

What were the 3 end of life concerns that lead to physician assisted suicide?

A
  • Loss of autonomy
  • Not participating in activities that made life enjoyable
  • Loss of dignity
34
Q

What was the median days between 1st request of asst suicide and death?

A

52

35
Q

What was the range of days between 1st request and suicide?

A

15 - 692

36
Q

What 3 countries is assisted suicide legal for adults in Europe?

A
  • Belgium
  • Netherlands
  • Luxembourg
37
Q

What European country allows for euthanasia of children older than 12 in some circumstrances?

A

Netherlands

38
Q

What european country allows any incurably sick child to request to end their suffering if concious and equipped with capacity of discernment?

A

Belgium

39
Q

What type of informed consent was used in Karen Quinlan’s case in 1976? What was the fundamental criterion?

A
  • Substituted judgment (father for hers)

- Medical prognosis (will patient get better?)

40
Q

What type of consent was used in Saikewicz’s case in 1976? What type of advanced directive was developed as a result of the case?

A
  • Institution acted as guardian, and had profoundly mentally challenged man that developed leukemia
  • No code order
41
Q

What resulted from the the case of Conroy in 1985?

A
  • Nephew’s “substituted judgement” of wanting the feeding tube removed from his uncle was overruled.
  • An objective standard needed to be used: “burdens… clearly & markedly outweighing the benefits”
42
Q

What resulted from the case of O’Connor in 1988?

A
  • Similar situation to Conroy in which nothing less than unequivocal proof of a patient’s wishes would suffice when the decision to terminate life support was at issue
43
Q

What was the first case on critically ill patients that was heard at the US Supreme Court?

A

Cruzen

44
Q

What was the result of the Cruzen case in 1990?

A
  • Missouri court required clearn & convincing evidence

- US Supreme Court upheld states’s rights to set their own standards indicating inconsistencies among states is OK

45
Q

What was the result of the Schaivo case in 2005?

A
  • 36 yo female was in persistent vegetative state, but parents tried to stop husband from removing feeding tube
  • Husband decided to have right to make the decision
46
Q

What is an end of life team?

A
  • Assist patient and health care delivery team in dealing with patients who are dying and are close to death
47
Q

What cultural issue may affect individual’s perspectives on critically ill & dying patients?

A

Spirituality/ religion

Ethics (5 decks)

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