End of Life

Question 1

Where do the majority of people die?

Answer 1

Within hospital

Question 2

Overall ethics in death

Answer 2

Who decides:

• Admission to ITU
• Screening for genetic disease

How:

• Treatment withdrawal
• Sedation

When:

• Resuscitate?
• Euthanasia?

Where:

• Hospital versus home?
• Hospice?

Question 3

Achieving a good death was dominated by what in the past?

Answer 3

Religion

Question 4

Achieving a good death is dominated by what in western world?

Answer 4

Medicine currently - The idea of someone having autonomy over their death is considered a good death

Question 5

Things that could influence the idea of a good death?

Answer 5

• Religion
• Culture/tradition
• Doctors
• Patients
• Relatives and friends

Question 6

In the modern world what could lead to a bad death?

Answer 6

The concept of loss of autonomy, whereby someone has lost the ability to make or communicate their decisions e.g. stroke or dementia

Question 7

What is a big change in modern causes of death and why does this pose a challenge?

Answer 7

In the past most deaths where acute, from infectious disease most commonly.

In modern day more people are dying of cancer, heart disease, dementia etc with the progression often slow lasting months or even years. This poses real challenge in how someone can die well when suffering from a degenerative disease.

Question 8

How may someone keep their autonomy in death?

Answer 8

• Palliative care
• Voluntary withdrawal of drug treatment
• Voluntary euthanasia (Not currently legal in the UK)

Question 9

What can improve quality of life in death?

Answer 9

• Caring attitude of staff
• Family visits
• Physical environment
• Autonomy
• Feeling safe
• Not feeling isolated
• Hobbies i.e. art
• Smoking, bad food etc

Question 10

What can diminish quality of life in death?

Answer 10

• Loss of independence
• Loss of autonomy
• Pain
• Fear
• Feeling like a burden
• Loss of ability to participate in hobbies
• Removal of things one may enjoy e.g. smoking, foods

Question 11

If unsure if a patient is a DNR what action should one take?

Answer 11

If in any doubt, doctors have a duty of care to save life and preserve function

Question 12

What is the UK’s stance on euthanasia and physician assisted suicide?

Answer 12

It is currently illegal

Question 13

Can doctors hasten death?

Answer 13

They must not intend to hasten death, but may in certain circumstances administer treatment that will hasten death (Doctrine of Double Effect)

Question 14

If a patient refuses treatment and it will lead to their death what should you do?

Answer 14

If the patient is autonomous then they have the right to refuse treatment regardless of the end result

Question 15

If a patient requested a treatment that is not indicated what should you do?

Answer 15

A patient cannot demand a treatment from a doctor, however if denied a treatment they are entitled to a second opinion

Question 16

What is the issue with rationing of treatments?

Answer 16

Some treatments may be indicated but are not affordable

Question 17

What is a family members role in medical decision making?

Answer 17

They have no role unless:

• They have been legally appointed proxy decision maker
• The patient lacks capacity

Question 18

What determines incapable?

Answer 18

Inability to:

1) Acting, or
2) Making decisions, or
3) Communicating decisions, or
4) Understanding decisions, or
5) Retaining the memory of decision

Question 19

What must be taken into account when someone loses capacity?

Answer 19

1) Their past and present wishes

2) The views of relevant others

Question 20

In terms of intervention in someone incapable what is of most importance?

Answer 20

That the intervention benefits them

Question 21

The duties of a doctor registered with the General Medical Council?

Answer 21

Patients must be able to trust doctors with their lives and health.To justify that trust you must show respect for human life and make sure your practice meets the standards expected of you in four domains

Question 22

Knowledge, skills and performance in terms of duties of a doctor?

Answer 22

Make thecare of your patient your first concern.

Provide a goodstandard of practice and care:

• Keep your professional knowledge and skills up to date.
• Recognise and work within the limits of your competence.

Question 23

Safety and quality in terms of duties of a doctor?

Answer 23

• Take prompt action if you think that patient safety, dignity or comfort is being compromised.
• Protect and promote the health of patients and the public.

Question 24

Communication, partnership and teamwork in terms of duties of a doctor?

Answer 24

Treat patients as individuals and respect their dignity:

• Treat patients politely andconsiderately.
• Respect patients’ right to confidentiality.

Work in partnership with patients:

• Listen to, and respond to, their concerns and preferences.
• Give patients the information they want or needina way they can understand.
• Respect patients’ right to reach decisions with you about their treatment and care.
• Support patients in caring for themselves toimprove and maintain theirhealth.

Work with colleagues in the ways that best serve patients’ interests.

Question 25

Maintaining trust in terms of duties of a doctor?

Answer 25

• Be honest and open and act with integrity.
• Never discriminate unfairly against patients or colleagues.
• Never abuse your patients’ trust in you or the public’s trust in the profession.

You are personally accountable for your professional practice and must always be prepared to justify your decisions and actions.