End of Life Ethics Flashcards

1
Q

list the medical standards for death

A
  1. total cerebral function, usually assessed by EEG as flat-line
  2. spontaneous function of the respiratory system
  3. spontaneous function of the circulatory system
  • brain death: irreversible brain damage as manifested by absolute unresponsiveness to all stimuli, absence of all spontaneous muscle activity, including respiration, shivering and an isoelectric EEG for 30 min
    • all in the absence of hypothermia or intoxication by CNS depressants
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2
Q

a person can be legally dead even if their _____ continues to function, which was determined by the _____

A

a person can be legally dead even if their cardiopulmonary system continues to function which was determined by the Uniform Determination of Death Act (UDDA)

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3
Q

describe an advance directive and the 4 main types

A
  • an advance directive is a document by which a person makes provision for health care decisions in the event that, in the future, he/she becomes unable to make those decisions
  • the main types of advance directives are:
    • living will
    • durable power of attorney for health care
    • combination advance directive
    • protective medical decisions document (PMDD)
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4
Q

describe a living will

A
  • oldest type
  • a signed, witnessed (or notarized) document called a “declaration” or “directive”
  • most delcarations instruct an attending physician to withhold or withdraw medical interventions from its signer if he/she is in a terminal condition and is unable to make decisions about the medical treatment
  • attending physician might interpret the signers wishes and values differently
  • family members have no legal standing to interpet the meaning of the directive
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5
Q

describe a durable power of attorney for health care

A
  • the signer designates an agent to make health care decisions if the signer is temporarily or permanently unable to make such decisions
  • important that the signer carefully discusses his/her values, wishes and instructions with the agent before
  • does not require that the signer have a terminal condition
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6
Q

describe a combination advance directive

A
  • contains specific written directions that are to be followed by a named agent
  • since it’s impossible to predict all circumstances, specific directions may severely limit the discretion and flexibility that the agent needs and may restrict the agent’s authority in a way the signer did not intend
  • the specific written directions may not be altered through discussions between the signer and the agent; any changes necessitates a new document
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7
Q

describe a protective medical decisions document (PMDD)

A
  • in the PMDD the signer names a trusted person to make health care decisions in the event that the signer is temporarily or permanently unable to make such decisions
  • specifically prohibits assisted suicide and euthanasia
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8
Q

describe a patient’s right to refuse life-saving treatment

A
  • mentally competent adults generally have the right to refuse medical treatment except in cases of compelling state interest
    • the patient can understand the risks and benefits of the proposed treatment or refusal of treatment
  • courts have upheld the right of an adult to refuse potentially life-saving medical treatment on religious grounds, unless the individual is:
    • mentally incompetent
    • the parent and sole provider of young children
    • a pregnant woman
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9
Q

list the states interests

A
  • preservation of life
  • prevent suicide
  • protect third parties
  • integrity of medical profession
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10
Q

describe passive vs. active physician assisted suicide

A

passive = allowing the patient to die

active = causing the patient’s death

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11
Q

describe the arguments in favor of PAD

A
  • respect for autonomy: decisions about time and circumstances of death are personal; competent people should have right to choose the timing and manner of death
  • justice: competent, terminally ill patients have the legal rights to refuse treatment that will prolong their deaths; those suffereing but do not have the option of refusal have the same rights–PAD is their only option
  • compassion: suffering means more than pain, physical, existential, social and psychological burdens; PAD may be a compassionate response to unremitting suffering
  • individual liberty vs. state interest
  • honesty and transparency
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12
Q

describe the arguments against PAD

A
  • sanctitiy of life
  • passive vs. active distinction
  • potential for abuse
  • professional integrity
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13
Q

describe the 2 laws for surrogate decision makers

A
  • hierarchy surrogate consent laws
  • consensus surrogate consent laws (Colorado and Hawaii)
    • consensus statutes require that all reasonably available “interested persons” come to a consensus about who should act as the decision-maker
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14
Q

who cannot be a surrogate decision maker?

A
  • your treating healthcare provider cannot be your healthcare surrogate
  • an employee of a treating healthcare provider UNLESS you are related to that employee
  • an owner, operator or administrator of a healthcare facility serving you cannot be your healthcare surrogate
  • an employee of an owner, operator or administrator of a healthcare facility cannot be your healthcare surrogate UNLESS you are related to them
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15
Q

representative of never competent patient cannot _____ or _____ from a patient unless the patient is in an end-stage condition or permanently unconscious without first petitioning the court

A

representative of never competent patient cannot withhold or withdraw life sustaining medical treatment from a patient unless the patient is in an end-stage condition or permanently unconscious without first petitioning the court

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