Death and Dying Flashcards
True or False: modern medicine has enabled people to survive illnesses that once caused death
true
Ventilators and feeding tubes allow medical practitioners to do what for patients?
sustain their life from weeks, months even years after traditional standards would say they’re dead.
21 y/o admitted to NJ, suffered cardiopulmonary arrest, placed on ventilator, tracheotomy, nasogastric tube, comatose, permanently vegetative, EEG was absnormal, brain scan was within normal limits
Karen Ann Quinlan Case
How many months was Karen Ann Quinlan comatose while her body deteriorated?
9 months
True or False: Loss of heartbeat, body color, and stiffness (rigor mortis) are considered criteria for death
true: debate over using cardiac definition or brain oriented definition of death.
Cardiac Death
heart stops functioning, legal death, irreversible loss of cardiac function
True or False: patients who are clinically dead may not be resuscitated with CPR
false, they can (dnr?)
caridiac death causes problems with what?
organ transplants ( heart needs to be beating)
When can cessation of pulse and breathing be reversable?
drug overdose, hypothermia
brain oriented death
irriversible cessation of all brain function
brain is dead the person is considered
deceased, dead
An irreversible brain condition where the patient is in a deep state of unconsciousness is called…
Persistent Vegetative State (PVS)
What are the three Harvard Criteria for irreversible coma ?
Patient is unreceptive and unresponsive, unaware of external stimuli, no spontaneous movements of breathing, no reflexes, fixed dilated pupils, lack of eye movement, lack of dep tendon reflexes.
Irreversible coma is also known as
brain death
Before the ventilator can be removed, what must be declared?
Brain death
What requires an EEG to determine absence of brain activity, then repeated again in 24 hours?
Harvard Criteria
Any individual, who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead.
Uniform Determination of Death Act (1980)
Withdrawing life sustaining treatment
discontinues treatment after it’s been started (artificial ventilation)
withholding life-sustaining treatment
never started, harder to stop once started,
euthanasia
good death
right to die, aid in dying, assisted suicide
euthanasia
intentional killing of terminally ill
active euthanasia
withholding medical interventions to only serve to sustain life
passive euthanasia
dying process is neither inhibited or accelerated
passive euthanasia
Jack Kevorkian, MD
Active Euthanasia
Arguments in favor of euthanasia
autonomy, harvesting viable organs, relief for family of patient with incurable disease, end terminal ly ill person’s suffering
Arguments against euthanasia
terminally ill patients known to recover, modern tech may find a cure, people may use it to relieve financial burden, it could be used indiscriminately, not good for society to have physicians kill patients or patients to kill themselves
Against permitting assisted suicide saying it would eventually lead to diminishing respect for life
slippery slope
woman PVS for 8 years after auto accident. feeding tube, , parents fought to have it removed. died 12 days after removal
Nancy Cruzan (1983)
woman PVS, medical malpractice lawsuit won, husband wanted to remove wife’s feeding tube, parents opposed, pathologists said she uttered “stop”, died 15 years and 13 days after her accident
Terri Schiavo Case (1990)
Death is the result of another persons intended action or inaction
direct killing
death is the result of an unintentional action of another person
indirect killing
an action may have two consequences, desired and undesired
principle of double effect
treatment or procedures that is morally required
ordinary means
procedures and treatments that are morally expendable
extraordinary means
Right to Die Legislation or Right to Refuse treatment
patients have the right to refuse treatment, courts have rules that patients must be mentally competent, patient’s refusal places their lives in danger, legal action sometimes results (guardian appt)
stages of dying
denial, anger, bargaining, depression, acceptance
DABDA
Who came up with the five stages of the dying process?
Dr. Elizabeth Kubler-Ross
Refusal to believe dying is taking place
denial
patient is angry with everyone
anger
gain time by making promises, be patient
bargaining
deep sadness over loss of health, independence and eventually life. sadness about leaving loved ones, withdrawn
depression
sense of peace and calm, i am ready to die
acceptance
These measures can assist with making healthcare decisions based on clinical factors, cost and issues that the patient believs are important
Quality of Life Issues
Quality of Life Measures include (name 4)
general health, physical functioning, role limitations, pain, social function, vitality, mental health
True or False: Most terminally ill patients wont live long enough to become addicted to heavy doses of narcotics
true, although physicians are still reluctant to do prescribe them
True or False: dying patients often spend most of their last days in comfort
false, they are in moderate to severe pain
The fundamental responsibility of physicians to relieve pain
HIppocratic Oath
True or False: Few physicians believe that patients pain and suffering should be controlled with the use of adequate medications
False: MANY physicians believe it.
9 million Americans live with cancer, 2/3 with advanced disease have significan pain. How much receive adequate pain control?
only half!
Originated in France to keep terminally ill patients as pain free as posible
Hospice Care
Hospice Care is also known as
death with dignity
Focuses on comfort measures, emotional support and pain free environment
Hospice Care
Hospice patients are typically there during their last few ____ of life.
weeks
True or False: During hospice, patients are kept awake and alert so they can spend some of their last moments with their family members.
True
Total care of patients whose disease in no longer responsive to curative therapy
Palliative Care
Palliative care is meant to provide ____ of pain and suffering.
relief
Allows people with terminal illness to obtain money from life insurance policies by selling them
Viatical Settlements
Viatical Settlements are _% - __% percent discount on face value of patients insurance to have ___ access to money
20 - 50, immediate
What are some things Viatical Settlements are used for?
medical and nursing care during final illness, vacation with family, experimental medical treatment that health insurance wont cover.
Mandates that adult patients receiving either medicare or medicaid be asked if they have an advanced directive or want information on the patient self-determination directives (living will)
Advance Directives
The Federal Patient Self-Determination Act (1991)
If someone attempts suicide they may be place in ________ care if the present ______ to themself or others
psychiatric, danger
