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Bioethics > Death > Flashcards

Death Flashcards

Learn about Dying

1
Q

Death

How has death reduced in Dev Nations?

A
  • Increased Average Life Expectancy due to better medicine
    • Lots of eliminated diseases ⤇ 54% ☟ Mortality from 1900 ➨ 2010
    • ☝︎ Hygiene
    • ☝︎ Healthcare access
  • Lower Childhood Mortality
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2
Q

Death

Why do Men die before Women?

A
  1. Bigger Risks
  2. Increased heart disease risk
  3. ☟social connection and going to doctor
  4. ☝︎ suicide success
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3
Q

Death

What determines longer lifespan

A
  1. Height: Shorter = Better
  2. Ethnicity
  3. Socioeconomic Status: Higher = Better
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4
Q

QOL Old People

Why is it low and what does it cause?

A
  • Disabilities, Loneliness
  • Most healthcare costs ain US
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5
Q

Death

How has life span decreased?

A
  1. No universal Healthcare
  2. ☝︎Obesity and correlating diseases
  3. ☝︎Childhood Mortality
  4. ☝︎OD deaths
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6
Q

Medical Advances

What advances have increased life span?

A
  1. Artificial feeding
  2. Dialysis
  3. Cardiopulmonary Bypass (CPB)
  4. Mechanical Ventilation
  5. Defibrilation and Artifical Pacemaker
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7
Q

Med Advances

Why are they bad?

A
  • Lasts a few years and is expensive
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8
Q

Dead

Definition

A
  • 60s: Brain, Lungs, Heart Stopped
    • But aft 60s, could continue heart beating w/o brain and lungs
  • Cardiopulmonary Failure Definition: Stop Breathing / Heart Stops Beating
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9
Q

Dead

How and why is a heart harvested?

A
  • Needs to be beating for transplant
  • Gotten from brain dead individual
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10
Q

Dead

Harvard Brain Death Committee

A
  • 1968
  • Brain Death = Irreversible Coma
  • 4 Criteria for brain death:
    1. Unreceptivity and unresponsivity to external stimuli
    2. No movements or breathing
    3. No reflexes: Fixed, dilated pupil, no reaction
    4. Flat EEG
  • Losing Identity = Death
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11
Q

Coma

What is it?

A
  • Loss of conciousness
  • Closed Eyes
  • No pupil response
  • Not awakened by talk or touch
  • Breathing on own but irregular
  • Decreased brain function
  • Usually less than several weeks
  • Like Anesthesia
  • NOT SLEEP
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12
Q

Coma

What causes it?

A
  1. Medically-Induced: ☟O2 needs
  2. Illness
  3. Injury
  4. Aneurysm
  5. Blocked Artery
  6. Diabetes
  7. Alcohol and Drugs
  8. Drowning
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13
Q

Coma

How is it evaluated?

A
  • Levels of Coma
  • Levels of responsiveness
  • Rancho Los Amiogo Scale (while emerging)
  • Glasgow coma scale: 3(worst) ➞ 15 (while in coma)
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14
Q

Coma

Coma vs Vegetative State

A
  • Awake but unresponsive
  • Often emerge from deeper coma into vegetative coma
  • No response to stimuli
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15
Q

Coma

What is a Vegetative State

A
  • Last > few months→ most irreversible → Permanent (>12 mo)
  • Very poor outcome
  • Deep unconsciouness and unawareness
  • wakeful but profound unresponsiveness
  • Non-functional cerebral cortex
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16
Q

Coma

What can people in vegetative state do?

A
  • Eyes may follow
  • Laugh or cry without reason
  • Grind teeth, swallow, smile, shed tears, grunt, moan, scream
  • No external stimuli
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17
Q

Coma

Persistent Vegetative State

A
  • Feeding tube/ intervenous feeding can keep alive
  • Previously would have starved to death
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18
Q

Coma

Recovery

A
  • Depends on Case:
    • Diabetes = quick
    • Drugs and alcohol = quick
    • Brain = long/never
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19
Q

Drugs

Drug abuse impacts

A
  1. Addiction
  2. Medical: Neurotixicity. AIDS, Cancer, Mental illness
  3. Social
  4. Economic: $3.73 Triilion
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20
Q

Drugs

Addiction Definition

A
  • Continuing, compulsive use of a substance that occurs despite negative consequences to the user
21
Q

Drugs

What does it affect/is affected by?

A
  • Young brains more susceptible: brain “molds” around activity
  • Multiple factors:
    • Biology / Genes: Mental Health
    • Environmental: Trauma
    • Brain Mechanisms
22
Q

Drugs

Why take drugs?

A
  • Feel Good: Novel feelings, sensations, experiences
  • Turns into Feeling Better: Lessen anxiety, worries fears, depression, hopelessness
23
Q

Addiction

Affected Brain Regions

A
  1. Activate Nucleus Accumbens: Motivation + pleasure ➞ drugs activate: CRAVING SENSATION
  2. Activate Ventral Tragmental Area (VTA): pleasure center with lots of connections to N.A. ➞ RUSH SENSATION
  3. Depressed Frontal Cortex: Worse decision making and altered memories
  4. Serotonin and Dopamine increased
24
Q

Addiction

Olds and Milner Experiment

A
  • Animal Model for addiction in humans
  • How it was conducted
    1. Put electrode in NA
    2. Rate stimulated with pedal
    1. Pressed many times per hour
    2. Did it while starving and dehydrating themselves
      1. Activated and sought activation even with negatvie consequences
25
Q

Addiction

Taking drug for first time

A
  • First consumption leads to activation skyrockets quickly and depresses NA ➟ feeling awful
26
Q

Addiction

∆FosB

A
  • Addiction Chemical
  • Takes extremely long for levels to decrease
  • Affected by genetic history: Increases ∆FosB at higher increments
27
Q

Addiction

Addiction with Genetics

A
  • Fewer dopamine receptors ➞ Increased addiction
  • Introverts lower risk for addiction, extroverts opposite
28
Q

Addiciton

Addiction with Environment

A
  • Stress
  • Early abuse
  • Witnessing violence
  • Those around you using
  • More use when in bad circumstances vs good ones: Cages vs rat park
29
Q

Opioids

Order of highest OD Deaths

A
  1. Synthetic
  2. Psychostimulants
  3. Cocaine
  4. Prescription Opioids
  5. Heroin
  6. Benzodiazapines
  7. Antidepressants
30
Q

Opiates

Poppy Seed Opiates

A
  • Morphine and Codeine
  • Opium comes from poppy seed as a highly addictive narcotic drug
  • Natural morphinone/codeinone
31
Q

Opiates

How they work

A

Activates/ Mimics endorphins ⇒ Pain relief

32
Q

Opiates

Three OD Waves

A
  1. Wave 1: 1990s: rise in Prescription Opioid deaths
  2. Wave 2: 2010: Rise in Heroin Deaths
  3. Wave 3: 2013: Synthetic Pain Killers Deaths
33
Q

Opiates

Misusers

A
  • 11.4 million / 4.2% of the population = Rx Pain Reliever Misusers
  • 886,000 = Heroin
  • 562,000 = Both
34
Q

Opiates

Triplicate vs Nontriplicate System

A
  • Trip: ensuring Monitoring drug prescriptions
35
Q

Opiates

Heroin

A
  • 1897: Synthesized by Bayer
  • Tried to make morphine into codine, but accidentally made heroin
  • Binds to heroin receptors and goes through BBB quickly
  • Intravenous Injection
36
Q

Opiates

Heroin Effects

A
  1. Slows down circulation
  2. Depresses bowel activity
  3. Suppresses cough reflecxes and slows down breathing
  4. Sedation and dizziness
  5. Irregular periods and lost interest in sex
37
Q

Opiates

Fentanyl

A
  • 50-100x potent vs Heroin
  • Mixed with alcohol and rise in effects
38
Q

Opiates

Narcan

A
  • Competitive antagonist
  • Binds to opioid receptor
  • Shields from further OD by not allowing other opioids to bind
39
Q

John Stuart Mill: The Rickety Bridge

What is it?

A

If a rickety bridge exists, what is the government’s role in the matter?
1. Sign?
2. Close the bridge?
3. Do nothing?

40
Q

John Stuart Mill: The Rickety Bridge

Case Study #1: Tobacco

A
  • 1999-2007: US vs Philip Morris
  • Used RICO Act(Racketeering Law)
  • Prohibited ad words and corrective statements on addiction
  • Billions for health damage
41
Q

Case Studies for John Stuart Mill: The Rickety Bridge

Government Possible Roles For Case #1

A
  1. Raise age restrictions: similarities to alcohol
  2. Raise taxes on cigarettes: harder to smoke + rethink economic choices
  3. Ban smoking in all public areas: Go against freedom
  4. Make cigarettes illegal everywhere for everyone
  5. Keep the law as it is
42
Q

Case Studies for John Stuart Mill: The Rickety Bridge

Government Possible Roles For Case #2

A
  1. Raise age restrictions: similarities to alcohol
  2. Raise taxes on cigarettes: harder to smoke + rethink economic choices
  3. Ban smoking in all public areas: Go against freedom
  4. Make cigarettes illegal everywhere for everyone
  5. Keep the law as it is
43
Q

Case Studies for John Stuart Mill: The Rickety Bridge

Government Possible Roles For Case #3

A
  1. Move off Schedule I: must research but can’t on Schedule I
  2. Legalize recreational & palace high taxes and age restrictions like tobacco
  3. Keep the laws as they are: states may vary
44
Q

Case Studies for John Stuart Mill: The Rickety Bridge

Government Possible Roles For Case #4

A
  1. Ban them - addiction therapy,
  2. Invest in research for new drugs - people in need,
  3. Prohibit advertising drugs to consumers
  4. Prohibit online pharmacies
  5. Public education efforts
45
Q

Case Studies for John Stuart Mill: The Rickety Bridge

Case #2: Vaping

A
  • July 2020: 758 lawsuits against Juul and others
  • Deceptive Marketing
  • Bleeding in brain
  • Lung injuries/deaths
46
Q

Case Studies for John Stuart Mill: The Rickety Bridge

Case #3: Marijuana

A
  • 1970 Controlled Substances Act, Schedule I (on par with heroin)
  • Gonzales v. Raich (2005)
  • Supremacy clause ⇒ National laws > State Laws
  • Patchwork of laws: ☝︎ Ignored by Pres and fed govt
47
Q

Case Studies for John Stuart Mill: The Rickety Bridge

Case #4: Opioids

A
  • 25% misuse, 10% addiction, 5% transition to heroin
  • 2016-17: doctor shopping
  • One doc: 500,000 doses
  • Lawsuit against internet pharmacies and doctors
    • Mallinckrodt, Insys, Purdue bankruptcies
48
Q

Medical Decisions for Minors

Big conflict

A
  • Minor’s bodily autonomy/ QOL vs Parent’s responsibility as ward
  • Also determined by how necessary the treatment is and if ther are alternatives
  • Age of child to determine their autonomy

Bioethics (12 decks)

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