End of life Flashcards
What factors change the concept of a good death?
Faith cultures
Individualist society - promotion of personal autonomy
Multicultural society - multiple beliefs
What are factors that make a death good?
Communication - patient, carers, relatives, healthcare team Symptoms well controlled Not distressing Time to plan Preferred place of death
What are factors that make a bad death?
Poor communication Perception of failure of health care team Distressing symptoms Sudden Catastrophic event - bleed No time to plan ahead or achieve goals Disagreement
What are the 4 most common preferred places of death?
At home
In a hospice
In a hospital
In a care home
How is quality of life enhanced at end of life?
Caring attitude of staff Family visits Physical environment Maintaining control Feeling safe/not alone Art sessions
What factors diminish quality of life at end of life?
Lost independence
Lost activities
Pain/fear of pain
Feeling a burden
What is collusion?
A secret agreement made between clinicians and family members to hide diaagnosis of a serious or life-threatening illness from the patient
What are reasons families may request collusion?
Disclosure causes patient to lose hope
Disclosure leads to depression
Disclosure hastens the progression of the illness and death
Disclosure increases suicide risk
Disclosure may cause psychological harm to patient
Family members may be in denial
Family members may be in conflict
Why does collusion go against principles of best clinical practice? (patient factors)
At odds with autonomy
Breaches patient confidentiality
Unable to give informed consent if unaware of underlying illness
May not be able to complete unfinished business prior to death
May sense something amiss and distrust
Many suspect diagnosis
Why does collusion go against principles of best clinical practice? (family factors)
Have to bear burden of being untruthful or even deceptive to loved ones which may lead to guilt
Barrier to communication as family members become avoidant
Families have no guidance in making treatment decisions, especially closer to end of life
Why does collusion go against principles of best clinical practice? (Clinician factors)
Breakdown of clinician patient relationship and loss of trust
May face treatment non-compliance from patients and may be unable to provide optimal treatment
What are features of DNACPR forms?
Not a legal document
Record of a decision
Provide guidance for clinicians who do not know the patient
What is guidance for DNACPR?
Patients must be made aware of DNACPR form
If patient lacks capacity inform those close to patient without delay
When there is clinical certainty, DNACPR will remain in place WITHOUT REVIEW
If a patient requests to withdraw from treatment, should you comply, even if it will lead to their death?
If they have capacity - yes
What are factors of consideration when patients are withdrawing from treatment?
Communication is key
Planning and preparation
When treatment is started patients should understand it can be withdrawn if they no longer want it
Symptoms should be anticipated and managed effectively
When can treatment be withdrawn in a patient with no capacity?
If patient is in a state where treatment is not able to provide a quality of life the patient would find acceptable
When is it acceptable to let a patient die?
Medical technology is useless in the scenario
Patient VALIDLY refuses a medical technology
What happens if a doctor allows a patient to die when acceptable criteria are not met?
Case of medical negligence
What is euthanasia?
Act of deliberately ending a person’s life to relieve suffering
What is assisted suicide?
Deliberately assisting or encouraging another person to kill themselves
What is physician assisted suicide?
Prescribing lethal drugs intended explicitly to end a life - person takes medication themselves or is assisted in some way
What are arguments for euthanasia?
Suicide is legal - those who are so disabled they can’t take their own life are disadvantaged
Withdrawing and withholding life-prolonging treatment is widely accepted and practiced
Suffering associated with some diseases outweighs benefits of continuing to live
Respect for patient autonomy
What are arguments against euthanasia?
Good palliative care obviates need for it
Discourages palliative care research
Vulnerable patients at risk - coercion, freeing up medical resources
Slippery slope - may lead to involuntary euthanasia for people deemed undesirable
Affects other people’s rights, not just the patients
Contrary to aims of medicine
