End of life

Question 1

All patients have a right to life and a right to care, so if in doubt Doctors have a duty of care to safe life and function.

When can this be “broken”?

Answer 1

Doctors can give treatments that hasten death if that is not the intention e.g. painkillers to someone terminally ill, they might hasten death but the benefit outweighs risk. (Doctrine of double effect)

Also doctors can withdraw treatment under certain circumstances. This is not keeping the patient alive and is not considered equivalent to killing them.

Question 2

Can doctors force treatment on patients?

Answer 2

No Patient Autonomy means that a paitent can refuse any treatment even if it results in certain death

Question 3

Can patients demand treatment?

Answer 3

Not if a doctor considers it not indicated

But they can get a 2nd opinion

Question 4

All patients are presumed to have capacity. They are only considered incapable if they cannot:

Answer 4

• Act
• Make Decisions
• Communicate decisions
• Understand decisions
• Retain memory of decisions

Question 5

How do we make decisions for a patient lacking capacity?

Answer 5

Take into account their past & present wishes as well as the views of family/significant others.

Any intervention we make must be for THEIR benefit

Question 6

What is an advance directive?

Answer 6

A wish regarding treatment made in advance by a patient in case they lose capacity.

They can refuse specific treatment but they cannot demand specific treatment

Question 7

When might an Advance Directive be considered invalid?

Answer 7

• Patient wasn’t capable when they wrote it or was under duress
• Any reason to doubt authenticity of it
• Treatment options have change
• Patient acts in a way that suggests they’ve changed their mind