End of life Flashcards
What is sentience?
This is the ability to feel painful/pleasurable stimuli.
What is the assumption regarding pain and sentience?
If we can feel pain, then measures should be made to provide the patient with pain relief.
Can unconscious patients or fetuses feel pain?
Patients who are unconscious or the fetus cannot feel pain, raising questions about their moral concern.
What does ‘human’ refer to in a moral context?
This is the belief that all human life is sacred – the sanctity of life.
What does the sanctity of life suggest?
All individuals are worthy of moral concern, prohibiting actions like abortion and euthanasia.
What is autonomy?
Autonomy is the mental capacity to make decisions based on our own thoughts.
What is required for doctors regarding autonomous decisions?
Doctors must accept autonomous decisions, while non-autonomous patients need others to decide for them.
What is personhood?
This notion states that being a person is not just biological; it involves having certain continuous mental states.
What happens if mental states are no longer possible?
The patient may no longer be considered a person and may not be worthy of moral concern.
What does potentiality refer to?
This criteria states that some patients may lack criteria for moral concern now but are likely to develop it in the future.
What is the significance of potentiality in medical ethics?
It justifies not harming the fetus or continuing life-supportive therapies until futility is reached.
What does the patient criteria state?
All patients are worthy of moral concern, and doctors have a duty of care to all patients.
What is the legal limit regarding treatment?
It is illegal to continue treatment if it is no longer beneficial.
What defines brainstem death?
Death of vital biological functions of the brain, including respiration and temperature control.
Why is brainstem death considered legal death?
Due to the lack of prospect for recovery.
What is the best interest in brainstem dead patients?
Withdrawal of care is inevitable; the patient is legally dead, and no treatment can be in their best interests.
What does ‘medically futile’ treatment mean?
Treatment that confers no benefit and is unlikely to be in a patient’s best interests.
Can doctors refuse treatment requested by patients?
A doctor can refuse to prescribe a treatment if they believe it is causing harm.
When does withdrawal of treatment conflict with best interest?
Withdrawal of life-sustaining treatment can seem like an active step that would end life.
What is the difference between act and omission in law?
Omissions are not crimes unless there was a duty to act, whereas actively causing harm is criminal.
What did Conway (2018) state about the difference between letting someone die and taking active steps?
The difference has been central to common law for centuries.
When is omission legal for doctors?
Doctors don’t have a duty to provide treatment if it is not in the patient’s best interests.
What did the Bland case (1993) establish regarding best interest and prolonging life?
Judges ruled that acting in best interests does not necessarily mean prolonging life.
What can be concluded from the Bland case?
Withdrawal of treatment can be considered an omission by law.
What does ‘best interest’ mean according to GMC?
It encompasses medical, emotional, and all other factors relevant to the patient’s welfare.
What should be considered when deciding if treatment is in the best interest of a patient?
I. Whether the treatment can benefit the patient (futility)
II. What the patient would have wanted (autonomy)
III. The nature of the treatment and its burdens.
What is the term for ‘can this treatment provide benefit’?
Futility.
What makes a treatment futile?
When the treatment won’t provide benefit.
Does futility mean that successful treatment would be impossible?
No, futility does not mean successful treatment is impossible.
What is the threshold for futility?
If the desired outcome is overwhelmingly improbable based on available scientific evidence.
What are the two main arguments underpinning the doctrine of futility?
- If success is unlikely, we cannot justify putting the patient through it.
- There is no distributive justice in devoting resources to it.
In what context is futility most often used?
In the context of the end of life, when there is no chance of survival outside an acute medical setting.
What are some problems with futility?
- It represents medical paternalism.
- Doctors may refuse treatments they don’t want to give.
- Subjectivity in defining ‘overwhelming’ improbability.
- Lack of objective evidence.
What have recent court judgments on withdrawing care used?
Futility arguments, with a broader, patient-centered idea of futility.
Why is autonomy important in treatment decisions?
It is a key factor in any decision around treatment.
How should we treat patients without autonomy?
We should attempt to find out what they would have wanted.
What did Archie’s mother report about his wishes?
He would want to be kept alive on life support to not leave her.
What is required for a minor to be considered competent?
- Maturity to withstand external influence.
- Intelligence to project into the future.
When is making a decision in best interest easy?
When autonomy and clinical benefit point in the same direction.
When is it challenging to decide whether to treat?
When the patient does not consent to treatment deemed in their best interest.
Does autonomy outweigh futility or best interest?
No.
What did Judge Hayden rule regarding the nature of treatment in Archie’s case?
The treatment was burdensome, injurious to dignity, and suspended Archie’s autonomy.
What did Archie’s parents argue about his wishes?
They argued he would want to be kept alive on life support.
What was established in the Airedale NHS trust vs Bland (1993) case?
Artificial nutrition counts as treatment, and it is legal to withdraw it when not in the patient’s best interests.
What influence has the Christian Legal Centre had on recent cases?
They have provided legal advice that sometimes breaks down trust between relatives and medical teams.
What organisation has been involved in giving legal advice to parents?
The Christian Legal Centre.
What is the Christian Legal Centre’s position on medico-legal issues?
They have a religious fundamentalist position.
How did a judge describe a key personnel of the Christian Legal Centre?
The judge described them as ‘fanatical and deluded’ and said their ‘malign hand’ was ‘inconsistent with the real interests of the parents’ case.’
What have medics reported about the Christian Legal Centre’s involvement in cases?
They attempt to break down the trust between relatives and the medical team.
What is the ‘ceiling of care’?
It is the predetermined highest level of intervention deemed appropriate by a medical team, aligning with patient and family wishes, values and beliefs.
What is an example of a ceiling of care?
Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders, common in frail patients and those with many co-morbidities.
Why are futility arguments central to the ceiling of care?
Futility arguments are central because DNACPR orders are rarely used when the likelihood of success is high.
How does the nature of treatment relate to the ceiling of care?
The nature of treatment is relevant as CPR is not seen as a dignified process.
How has COVID exacerbated the ceiling of care?
Many patients were made DNACPR without discussion or current clinical evaluation, to prevent resource diversion during resuscitation.
Does a patient have to consent to a DNACPR for it to be legally binding?
DNACPRs must include the patient in the discussion, but patients do not have to consent to it.
What is euthanasia?
Euthanasia is the act of deliberately ending a person’s life to relieve their suffering.
What is the goal of euthanasia?
Its goal is providing a humane death without excess suffering.
What are the two axes along which euthanasia can be categorized?
Voluntariness and activeness of the process.
What are the three levels of voluntariness in euthanasia?
Voluntary: competent, informed patient request; Involuntary: patient competent but not asked; Non-voluntary: patient not competent.
What are the two levels of activeness in euthanasia?
Active: doing an act of commission which leads to death; Passive: doing an act of omission or withdrawal which leads to death.
What form of euthanasia is the withdrawal of care/treatment?
Passive euthanasia.
Which type of euthanasia is illegal in the UK?
Active euthanasia.
What are arguments for euthanasia?
- Prolongation of life does not always equate to best interests. 2. Autonomy: we should be allowed to choose how to die. 3. Justice: it is unjust that some can end their life while others cannot.
What are arguments against euthanasia?
- Death is considered the ultimate harm. 2. Non-maleficence: legalizing euthanasia could lead to inadvertent harm.
What is the legal status of euthanasia in the UK
Euthanasia has no legal status in the UK and is treated as manslaughter or murder.
What is the difference between motive and intent?
Motive is the moving power behind an action; intent is the purpose to use a means to effect a result.
In UK law, is the weight on intent or motive?
In UK law, intent is given weight, not motive.
What is physician-assisted dying according to BMA?
It is doctors’ involvement in measures intentionally designed to end a patient’s life, either through prescribing lethal drugs for self-administration or administering lethal drugs directly.
What type of euthanasia is physician-assisted suicide?
If requested by a patient with capacity, it is voluntary euthanasia.
What attempts have been made to legalise euthanasia in the UK?
Attempts include the 1936 Lord Arthur Ponsonby proposal, 1969 Lord Raglan, 1976 Baroness Wootton, and several bills from 1997 to 2020.
Why has euthanasia not been legalised despite attempts?
The medical profession has historically resisted legalisation, believing it contradicts the primary goals of medicine.
What change occurred in the BMA’s stance on physician-assisted dying?
In 2021, the BMA reversed its opposition to legalisation and adopted a position of neutrality.
What is communitarianism?
Communitarianism is an ethical view that prioritizes the flourishing of society and treats trust as a fundamental ethical currency.
What is the communitarian view of euthanasia?
Significant changes can shift the balance within ethical ecologies, leading to unforeseen problems.
What is the doctrine of double effect?
It is permissible to do something with an aim for moral good, even if it has a morally bad side effect, as long as the intent is to achieve good.
What is a problem with the doctrine of double effect?
Critics argue it is impossible to determine someone’s true intention.
What is the legal precedent for the doctrine of double effect in UK law?
The ruling R vs Cox (1992) established that the doctrine applies only when the primary purpose is to relieve pain.
What is the status of assisted suicide in Switzerland?
Assisted suicide is permitted since 1942, as long as the motives are not selfish; euthanasia is illegal.
What is the status of euthanasia in Belgium and the Netherlands?
Euthanasia by physicians is legal if certain criteria are met; active euthanasia is legal.
What is the status of euthanasia in Canada?
Since 2016, both assisted suicide and active euthanasia can be administered by doctors; advance directives are allowed.
What are the humanitarian concerns regarding MAID in Canada?
Concerns include vulnerable individuals feeling pressured to end their lives rather than being a burden.
What are ‘slippery slope’ arguments?
They suggest that permitting one moral authority can lead to further permissiveness, resulting in situations that were not originally intended.
What is the stance of Canada’s Human Rights Commission on euthanasia?
Euthanasia cannot be a default for Canada’s failure to fulfill its human rights obligations.
What are ‘slippery slope’ arguments?
‘Slippery slope’ arguments are based on the idea that once a moral authority permits a step in one direction, users will push this permissiveness further, leading to situations that were never in the original framework.
How do communitarian arguments differ from slippery slope arguments?
Communitarian arguments suggest that the initial change alters how we inter-relate and see each other, our rights, and responsibilities, making it logical to behave differently.
What is humanism in the context of moral status?
Humanism provides grounds for moral status.
What does withdrawal of care entail?
Withdrawal of care occurs when treatment is futile, against autonomy, or burdensome/non-dignifying.
What is euthanasia or physician-assisted dying?
Euthanasia or physician-assisted dying is when life is unbearable.
What is the value of human life?
All human lives are of equal value; the value of human life is the value attached to it by that person.
