End of Life Flashcards
1
Q
Good death
A
- Communication
- Symptoms well controlled/not distressing
- Time to plan
- Preferred place of death
2
Q
Bad death
A
- Poor communication
- Perception of failure of healthcare team
- Distressing symptoms
- Sudden
- Catastrophic event
- No time to plan/achieve goals
- Disagreement
3
Q
Quality of life
A
Communication important to maximise QoL
4
Q
Factors which may enhance an individual’s quality of life
A
- Caring attitude of staff
- Family visits
- Physical environment
- Maintaining control
- Feeling safe/not alone
- Art sessions
- Smoking?
5
Q
Factors which may diminish an individual’s quality of life
A
- Lost independence
- Lost activities
- Pain/fear of pain
- Feeling a burden
6
Q
Request for Prognosis
A
- Some patients want to know, some don’t
- Families want to know: respect autonomy and confidentiality
- Give ‘gist’ not statistic
7
Q
Ethics of End of Life
A
- Capacity: understand, retain, process info. Fluctuates
- Power of Attorney: irrelevant if patient has capacity
- Benefit/best interest of patient
- Autonomy
- Family
- Conscientious objection: remove treatment (legal)
- Justice
- Ageism
8
Q
Collusion
A
Secret agreement made between clinicians and family members to withhold diagnosis of serious illness from patient
9
Q
Reasons for collusion
A
Best interest of patient
- Cause lost hope
- Depression
- Hasten illness
- Risk of suicide
- Psychological pain
Family members may be in denial, conflict or unaware of severity
10
Q
Collusion: patient factors
A
- Odds to autonomy and right to self-determination
- Breach confidentiality (tell family first)
- Inability to give informed consent for optimal treatment
- Unable to plan before death
- Distrust between relatives/clinician and patient
- Patient suspects diagnosis anyway
11
Q
Collusion: family factors
A
- Burden of dishonesty may cause guilt
- Barrier to communication at most important time
- Families won’t have guidance in making treatment decisions
12
Q
Collusion: clinician factors
A
- Clinician-patient relationship breakdown
- Loss of trust
- Unable to treat optimally (patient non-compliance)
13
Q
DNACPR forms
A
- Do Not Attempt Cardiopulmonary Resuscitation
- Not a legal document
- Record of decision and documented in notes
- Provides guidance for clinicians
- Patients must be made aware of DNACPR form (relatives if patient lacks capacity)
14
Q
Withdrawal of treatment: Patient choice
A
- Legal and ethical right to refuse treatment
- Battery: continuing unwanted treatment (patient has capacity)
- Communication is key for planning and preparation
- Treatment can be withdrawn at any point
- Symptoms should be anticipated/managed
15
Q
Withdrawal of treatment: No capacity
A
- Treat patient’s best interest
- Sometimes prolonging life is not in patient’s best interest (no improved quality of life)
