End of Life

Question 1

informed consent

Answer 1

insures pt autonomy, voluntary, informed, reasonable choices

Question 2

7 elements of informed consent

Answer 2

capacity, voluntary, disclosure of all info, practitioner recommended, assess pt understanding, time for reflection, legal authority

Question 3

comfort focused care

Answer 3

limit life prolonging treatment in favor of treatment that improves the quality of the time left

Question 4

is it ethical to have care plan if time of death is affected?

Answer 4

causal pathway, prognosis, pt preferences all part of it

Question 5

prognosis

Answer 5

principle of beneficence. how certain is prognosis? what is good quality of life?

Question 6

causal pathway

Answer 6

active killing never ok. passive, letting die is. withdraw vs withhold. nutrition/dehydration

Question 7

capacity

Answer 7

determined by physician, can vary. must understand relevant info and appreciate consequences. mental illness is not enough to preclude

Question 8

shared decision making

Answer 8

clinicians give best advice options, pt participates

Question 9

double doctrine

Answer 9

bad effect can be tolerated in attempt to achieve good palliative sedation, pain meds> death

Question 10

requirements for double doctrine

Answer 10

act can’t be wrong, intend good event only, bad can’t be means to a good. good is more important than bad,

Question 11

pt preferences

Answer 11

pt has right to refuse, even after loss of capacity. no idea pt preference?> best standard.

Question 12

surrogate decision makers

Answer 12

opinion takes precedence over best standard

Question 13

futility

Answer 13

care isn’t benefiting pt, may be causing harm

Question 14

narrow futility

Answer 14

no chance of effect, physician may say no (rare)

Question 15

broad futility

Answer 15

potentially inappropriate, procedural, must create mutually ok plan