End of life decisions in adults

Question 1

What is euthanasia?

Answer 1

the act of deliberately ending a person’s life to relieve suffering

Question 2

What does any form of euthanasia amount to?

Answer 2

murder or manslaughter

Question 3

Is there a defence for euthanasia?

Answer 3

no

no defence to say:
- patient consented
- ‘mercy killing’
- acting in patient’s best interests

Question 4

What is the Doctrine of Double Effect?

Answer 4

• that if doing something morally good has a morally bad side-effect it’s ethically OK to do it providing the bad side-effect wasn’t intended
• true even if you foresaw that the bad effect would probably happen

Question 5

What 2 things must be true for double effect to be used lawfully?

Answer 5

action must be appropriate treatment according to Bolam principles (accepted as proper by a responsible body of medical men skilled in that particular area)

motive must to be relieve suffering and not to shorten life

Question 6

Describe the Bolam principles

Answer 6

accepted as proper by a responsible body of medical men skilled in that particular area

Question 7

Describe the Suicide Act 1961

Answer 7

suicide is not an offence
encouraging or assisting suicide is an offence

Question 8

What is the DPP?

Answer 8

Director of Public Prosecutions (head of Crown Prosecution Service (CPS))

Question 9

What 2 stage test is used to decide whether to prosecute in a potential encouraging or assisting suicide case?

Answer 9

evidential stage = suspect must do an act capable of encouraging and assisting suicide and have intended to do it

public interest stage = ‘never been the rule that a prosecution will automatically follow’ whenever an offence has been committed

Question 10

What kind of decisions can competent patients make?

Answer 10

entitled to make unwide, eccentric and irrational decisions

Question 11

Can mentally competent patients refuse treatment?

Answer 11

if fully informed, their refusal of treatment has to be respected

Question 12

Can a patient demand treatment?
Define futile with regards to treatment options

Answer 12

if clinical believes treatment would be futile or clinically inappropriate, they are under no obligation to offer it

futile = a treatment that even though it may have a physiological effect, does not benefit the patient as a whole

Question 13

What type of care is ANH? (artificial nutrition and hydration)

Answer 13

medical treatment, not basic care

Question 14

What type of act is required for it to be murder?

Answer 14

a positive act - someone must actually do something (not omission)

Question 15

If it is proposed to withhold or withdraw ANH, when is prior authority from the court needed?

Answer 15

• when there is any doubt as to the patient’s capacity
• disagreement amongst the attending healthcare professionals
• evidence that the patient when competent would have wanted ANH to continue
• if the patient, even a child or incompetent adult, resists or disputes the withdrawal
• parents, relatives, partners, close friends, long term carers, assert that withdrawal is contrary to the patient’s wishes or is not in the patient’s best interests

Question 16

When are patients classed as approaching ‘end of life’?

Answer 16

likely to die within 12 months

Question 17

Outline the GMC’s decision making model when a patient lacks capacity to decide

Answer 17

assess patient’s condition
decide what is in patient’s best interests
check if patient has advanced directive
does patient have a power of attorney?
if no family - appoint an independent mental capacity advocate
resolve disputes

Question 18

When can treatment be withdrawn from adult patients who lack capacity?

Answer 18

if it is considered futile and no longer in their best interests