End of life Flashcards
Definition of Bioethics
Bioethics is the systematic study of human conduct in the area of the sciences of life and health, as this conduct is examined in the light of moral values and principles
What is the goal of medicine according to Hippocrates?
Not to extend human life but prevent suffering
Where is euthanasia legal?
In Switzerland
Is DNR euthanasia?
YES
Why can doctors get away legally from euthanasia?
Because their intention must never be to kill a patient but to relive suffering, so doctors write down that the drugs administered relieve suffering
What is active euthanasia?
The doctor causes the death
When was active euthanasia first legalized?
In 2002 Netherlands
Where can active euthanasia take place?
Luxembourg, Belgium, Spain and the Netherlands
What are the types of active euthanasia?
- Direct
- Indirect [palliative care]
When was palliative care entirely paid by the NHS in Italy?
2017
What is passive euthanasia?
the disease causes death: the doctor stops treating the disease
What is assisted suicide?
The patient expresses their own will and wants no longer to live and takes the drug prepared by the doctor/nurse
How does assisted suicide take place?
The drug is administered in a little glass containing 2 drugs: you are given a little chocolate because the drug is bitter, in 2 minutes you start having problems eating.
How does active euthanasia take place?
Through the administration of:
1. Thiopental sodium intravenously to induce general anaethesia or pharmacological coma
2. Pancuronium bromide to paralyse muscles and stop breathing; opium drugs are given to prevent suffering
3. Potassium chloride to induce cardiac arrest in 1 minutes
Which method of captial punishment is used in US executions?
potassium chloride
Describe the state of a patient in a coma
- non aware
- no responsiveness to stimuli
- eyes closed
- no sleep-awake cycle
- mechanical ventilation
Describe the state of a patient in the vegetative state
- spontaneous breathing
- regular sleep pattern
- automotive response to stimuli
- non aware
What is temporary vegetative state?
6-12 months
What is persistent vegetative state?
up to years
Give a brief description of vegetative state
An integrated condition in which parts of your brain works and others don’t.
Describe the case study Eluana Englaro
Born in Lecco in 1970: victim of a critical road accident in 1992, at age 22. She was admitted to the ICU and diagnosed with vegetative state
When did Eluana Englaro father ask to suspend nutrition and health (N&H) and what was the outcome of the request?
January 1999
The court rejects the request
When did the Supreme Court authorise the suspension of the treatment and under which conditions?
2007
1. Clear consistency with patient’s will
2. No possibility based on scientific literature and previous cases to regain consciousness and environmental perception
When did Eluana Englaro pass away?
June 2008
What is fundamental in the case of vegetative state?
The living will
When was the living will legalised in Italy?
2017
What is the living will?
If you are over 18 and competent, you can choose which treatments would you not administered within certain healthcare conditions, by writing a document
Describe the case of Fabiano Antoniani, DJ Fabiano
Milano 1977, he got into a critical car accident–> tethraplegia and blindness.In 2017, he was accompanied by Marco Cappato to a Swiss clinic to be administered assisted suicide. Cappato was then accused of aid to suicide. However, in 2019, the court deemed Cappato not punishable as art. 58 in constitution said that aid to suicide is legitimate to the benefit of patients who want to stop suffering
When was the first assisted suicide approved in Italy?
2021
Main determinants of brain death
interrupted blood flow to the brain:
- 4/6 minutes first lesions
- 8/10 minutes cerebral death
Under which conditions did the Netherlands authorise active euthanasia?
- the patient’s suffering is unbearable
- the request must be voluntary and persist over time
- the patient must be fully aware of his/her condition
- consultation with at least one other independent doctor who needs to confirm the consiitons
- Must be carried out in a medically appropriate fashion
- The patient is at least 12 years old and requires parental consent up to 16
Which was the second country to legalise euthanasia?
Belgium
When was euthanasia for babies legalised and where?
Netherlands 2007
When was euthanasia for demented patients legalised and how?
2020 Netherlands
Given Valium + Pentobarbital
