End of Life Flashcards
What are some features of a “good” death?
Communication - patient, carers/relatives, healthcare team
Symptoms well controlled
Not distressing
Time to plan
Preferred place of death
What are some features of a “bad” death?
Poor communication
Perception of failure of healthcare team
Distressing symptoms
Sudden
Catastrophic event
No time to plan ahead or achieve goals
Disagreement
What is Collusion?
Collusion refers to a secret agreement made between clinicians and family members to hide the diagnosis of a serious or life-threatening illness from the patient
What are some reasons families may wish to collude?
Disclosure causes the patient to lose hope
Disclosure leads to depression
Disclosure hastens the progression of the illness and death
Disclosure increases the risk of patient suicide
Disclosure may cause psychological pain for the patient
Family members themselves may not be aware of the nature and severity of the illness
Why collusion goes against the principles of best clinical practice?
Family factors
Family members will have to bear the burden of being untruthful or even deceptive to their loved ones, which may lead to guilt later.
A barrier to communication is erected as family members become avoidant at a time when they are most needed by patients.
Families will have no guidance in making treatment decisions, especially closer to the end of life.
Why collusion goes against the principles of best clinical practice?
Patient factors
Collusion is at odds patient autonomy and to the right to self-determination.
Revealing the diagnosis to relatives before revealing it to patients breaches patients’ right to medical confidentiality.
Patients are unable to give informed consent if they are not aware of the underlying illness and thus may not obtain appropriate or optimum and timely treatment.
Patients may not be able to complete unfinished business and tasks prior to their deaths.
Patients who sense something amiss may come to distrust their relatives and clinicians.
Many patients suspect the diagnosis anyway, given their symptoms and physical deterioration.
Collusion is at odds patient autonomy and to the right to self-determination.
Revealing the diagnosis to relatives before revealing it to patients breaches patients’ right to medical confidentiality.
Patients are unable to give informed consent if they are not aware of the underlying illness and thus may not obtain appropriate or optimum and timely treatment.
Patients may not be able to complete unfinished business and tasks prior to their deaths.
Patients who sense something amiss may come to distrust their relatives and clinicians.
Many patients suspect the diagnosis anyway, given their symptoms and physical deterioration.
Why collusion goes against the principles of best clinical practice?
Clinician factors
Collusion results in a breakdown of the clinician-patient relationship and a loss of trust from the patient
Clinicians may face treatment non-compliance from patients and may be unable to provide optimal treatment, such as radiotherapy or chemotherapy
What is a DNACPR form?
A Do Not Attempt CPR form is a document issued and signed by a doctor, which tells your medical team not to attempt cardiopulmonary resuscitation (CPR)
Can a patient withdraw treatment?
It is a patients legal and ethical right to decide to refuse treatment
If the patient has capacity, the decision must be respected and complied with, even if this may lead to death
Continuing unwanted treatment is battery and this is a criminal offence
What is patient autonomy?
The right of patients to make decisions about their medical care without their health care provider trying to influence the decision
