End of Life Care Flashcards
how to achieve a good death?
In societies which adhere to a particular religion, death is managed according to the particular rites of
that religion, bringing people together when they feel most threatened. Often this involves passage
to the afterlife. In our current society at this time, many people don’t believe in an afterlife. We live
in an individualistic society which promotes personal autonomy; the rights of individuals to make their
own choices about how they should live or die. So, a ‘good death’ is seen as one where the individual
makes their own choices about their last days and months. Whereas a bad death is seen as one where
the individual has lost their autonomy and is unable to make or communicate decisions, eg dementia,
stroke. But we must remember that our society is multicultural, and the majority idea of a good death
may not be shared by minorities with different beliefs. What we are dying from has also changed. It is
much less common to die quickly from an infectious disease, for example. Now people may live with
a life-threatening illness, such as cancer, heart disease, dementia, for months or even years. A
challenge today is how to die well from the slow degenerative diseases of old age. Individualist
societies promote the personal autonomy of the dying, including palliative care and voluntary
euthanasia.
In the past the idea of a good death was dominated by religion but currently, in many western
countries it is dominated by medicine. The idea of what constitutes a good death has possibly
changed. Who or what decides what a good death is? Culture/tradition? Doctors? Patients? Relatives
and friends?
what is quality of life enhanced by?
caring attitude of staff family visits physical environment maintaining control feeling safe/not alone art sessions ?smoking
what is quality of life diminished by?
lost independence
lost activities
pain/fear of pain
feeling a burden
describe the duty of care, right to life and sanctity of life in regards to end of life care
o If in doubt, doctors have a duty of care to save life and preserve function
o Euthanasia and physician assisted suicide are illegal
o Doctors must not intend to hasten death, but may in certain circumstances administer
treatment that will hasten death (Doctrine of Double Effect)
o Not keeping alive versus killing (usually not considered equivalent)
describe autonomy and justice in regards to end of life care
o Patient autonomy allows the refusal of any treatment, even if refusing the treatment will
result in their certain death
o Patients cannot demand a treatment that a doctor does not consider indicated (but they
can get a second opinion)
o Remember that healthcare is rationed.; some treatment may be indicated but not
affordable
o Family members cannot make medical decisions for patients (unless they have been
legally appointed proxy decision maker and the patient lacks capacity)
describe capacity in regards to end of life care
o Patients can be presumed to have capacity
o They are only ‘incapable’ if they are incapable of:
§ acting; or
§ making decisions; or
§ communicating decisions; or
§ understanding decisions; or
§ retaining the memory of decisions
o Any intervention must be for their benefit
o Considering
§ their past and present wishes
§ the views of relevant others
describe advance directive/advance refusal of treatment in regards to end of life care
o Patients can refuse treatment; they cannot demand specific treatment
o Refusal may be invalid if:
§ The patient is not capable at time of writing or is or has been duress
§ There is reason to doubt authenticity
§ Does not apply if:
• Treatment options have changed
• Patient has acted in a way that suggests they have changed their mind
