End of Life Care

Question 1

To pinpoint the source of our distress about end of life care: 4 eras to explore

Answer 1

• Pt should be confortable with death, just as we are.
• We pride ourselves on being persuative communicators
• We recognize the impact of suffering, and know what to do about it.
• We like to believe that our assumptions are universally held, and thus dont constitute biases.

Question 2

How to responding to a patient’s request for burdensome tx?

Answer 2

1. Verify that the patient truly understands the decision he/she is making.
2. Acknowledging our own feelings of failure and helplessness.
3. Make sure the pt knows that all options remain open.

Question 3

Morals refer to

Answer 3

an individual’s own ideas and principles that guide the determinations of right and wrong that they use in their everyday life.

Question 4

Professional ethics

Answer 4

based on professionally accepted standards of behaviour, values and guiding principles.

Question 5

The principles of Biomedical Ethics:

Answer 5

Beneficence
Autonomy
Non-malfeasance (avoiding unnecesary harm)
Justice

Question 6

Withholding:

Answer 6

on tx and then stop it

Question 7

Withdrawing:

Answer 7

No starting something

Question 8

Withholding/withdrawing tx is ethically justifiable when done:

Answer 8

1. At the competent patient or Substitute decision-making request
2. Desired benefits will not be achieved
3. Anticipated benefits were not achieved
4. Burdens>benefits
5. Change in goals or priorities
6. Change in heath

Question 9

Palliative sedation is

Answer 9

titrating sedatives and pain killers to relieve pain, anxiety and/or suffering up to the point of total unconsciousness

Question 10

Physician assisted suicide is

Answer 10

involves a physician providing a patient with the medical means to end their own life. (Intervention prescribed by physician and used by patient.)

Question 11

Euthanasia is

Answer 11

an intentional action undertaken for the purpose of causing a patient’s death for compassionate reasons. (Intervention used by physician)

Question 12

If baby x dies following a decision to withhold medically administered forms of fluids and nutrition, the cause of death will be?

Answer 12

The underlying asphyxial injury that left the baby unable to suck or swallow (Underlying disease)

Question 13

Euthanasia is illegal?

Answer 13

Is not illegal but this is not legal either.

Question 14

The moral distinction between intended and foreseen consequences depend on:

Answer 14

The standard of care. Difference between giving 10x morphine dose (euthanasia) and wanted to relieve pain (appropriate palliative care).

Question 15

Doctrine of double effect:

Answer 15

provides that performing an act that brings about a good consequence may be morally right even though the good consequence can only be achieved at the risk of a harmful side effect. (foreseeable but unintended consequence)

Question 16

Why patient ask for hastened death?

Answer 16

• Wanting to control circumstances of death
• Futur poor quality of life, pain or inability to care for self
• loss of independence
• wanting to die at home

Question 17

Is patient refusal of life-sustaining tx is medical aid in dying?

Answer 17

NO

Question 18

Medical Aid in Dying

Answer 18

mean care consisting in the administrations or substances to an end-of-life patient, at the patient’s request, in order to relieve their suffering by hastening death.

Question 19

WHo can give medical aid in dying>

Answer 19

Physician only. (NOT nurses, NOT medical resident or other)

Question 20

Every institutions have the obligation to give medical aid in dying except:

Answer 20

• Palliative care hospice, BUT need to refer the patient to another place.
• Physician can refuse to give medical aid in dying, BUT need to refer the patient to the director of the institution.

Question 21

Quebec difference in the definition of medical aid in dying:

Answer 21

In Qc, it includes ONLY euthanasia and NOT assisted suicide.

Question 22

Conscientious objection: agent’s can refuse to provide a good or service if only:

Answer 22

• The agent has a core set of moral belief (ethical/religious)
• Providing the good or services is incompatible with the agent core beliefs
• Is based on her core moral belief.

Question 23

Core professional obligations justify several constraints on the exercise of conscience because:

Answer 23

-Obligation to respect patient dignity and refrain from discrimination, to promote patient health and well-being, and an obligation to respect patient autonomy.

Question 24

Physician assisted suicide is legal:

Answer 24

In Canada, NOT QC.

Question 25

Assisted suicide legally defined:

Answer 25

Aiding a physically incapable person in taking his/her own life.