End of Life Flashcards
What is collusion?
This refers to a secret agreement made between clinicians and family members to hide the diagnosis of a life-threatening illness from the patient
What are the three reasons why families wish to collude?
The disclosure could cause the patient to become depressed
The disclosure could hasten the progression of the illness and death
The family members may be in denial
How does collusion go against the principles of best clinical practice?
It goes against patient autonomy
If we reveal the diagnosis to relatives before the patient it breaches the patient’s right to confidentiality
The patient is now unable to give informed consent for treatment
The patient is unable to prepare for death
The family members bear the burden of being untruthful to their loved ones - which may lead to guilt later
What is a DNACPR form?
It is a form that means if a patient’s heart or breathing stops the healthcare team will not try to restart it
What is the legal status of a DNACPR form?
It is not a legal document rather a record of a decision
Who makes the decision about making DNACPR forms?
All individuals have the capacity to complete a DNACPR form
However, medical professionals can complete a DNACPR form against a patients wishes
In cases where patient lack capacity to make decisions about DNACPR forms, what should be conducted?
The clinician should first check to see if you have an ADRT that says you don’t want CPR
They should check to see if you have a lasting power of attorney - who can make the decision in the patient’s best interest
If they don’t have either of these, then the decision is made by a senior doctor
In cases where medical professionals complete a DNACPR form against a patients wishes, what should be done?
The patient must be told that a DNACPR form has been completed - doesn’t stand if the clinicians deems that psychical or psychological harm
It must be explained to the patient what a DNACPR is, and why the clinician feels CPR would not be suitable
In cases, where individuals disagree with a DNACPR decision, they can ask for a second opinion and review
In cases where patients wish to withdraw treatment to end their life, how do we manage this?
It’s a patients legal and ethical right to decide to refuse treatment - as long as they have capacity
However, clinicians who conscientiously object to this decision don’t have to conduct this and can refer to other colleagues
What do we do if patients start withdrawal of treatment and decide they no longer want it?
This is within the rights of the patient
In cases where patients are in a vegetative state and their family wish to withdraw treatment, how do we manage this?
The healthcare professionals and the family decide what is in the patient’s best interests
In cases where continuing to provide care ceases to be in the best interests of the patient, it can be withdrawn
What is an anticipatory care plan?
It is when the patient talks about what matters most to them when making plans for future care
This means there is less to think about if the patient becomes unwell
What is an advance directive (ADRT)?
It is an advance devision patients can make at any time to refuse certain types of treatment at some time in the future
What is the legal status of an ADRT?
It is only legally binding if it complies with the mental capacity act, it is valid and it applies to the relevant situation
What is euthanasia?
This is the act of deliberately ending a person’s life to relieve suffering
For example, a doctor administrating a lethal cocktail of drug explicitly to end a life
