End of life ethics Flashcards
What makes a good death (5)
Communication
- patient, carers /relatives, healthcare team
Symptoms well controlled
Not distressing
Time to plan
Preferred place of deathWhat makes a bad death (7)
Poor communication Perception of failure of healthcare team Distressing symptoms Sudden Catastrophic event, e.g. bleed No time to plan ahead or achieve goals Disagreement
What can quality of life be enhanced by? (7)
Caring attitude of staff Family visits Physical environment Maintaining control Feeling safe/ not alone Art sessions Smoking ?
What can effect quality of life? (4)
Lost independence
Lost activities
Pain/ fear of pain
Feeling a burden
A request for prognosis - ethical issues
Many patients do want to know their prognosis, others will not, Non-maleficence, Beneficence
Often family ask more - need to respect autonomy
- often give statistics or average prognosis
With giving a bad diagnosis to someone elderly, what are the ethics that should be considered? (4)
Capacity
Benefit/best interest
Autonomy
What if the daughter has Power of Attorney?
What is collusion?
a secret agreement made between clinicians and family members to hide the diagnosis of a serious or life-threatening illness from the patient.
KEEPING INFO from patient
Collusion - why might you do this (8)
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
Family members may be in denial
Family members may be in conflict
Why does collusion go against the principles of best clinical practice - PATIENT FACTORS
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 t 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 does collusion go 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 does collusion go against the principles of best clinical practice - CLINICIAN FACTORS
Collusion results in a breakdown of the clinician–patient relationship and a loss of trust between patients and clinicians.
Clinicians may face treatment non-compliance from patients and may be unable to provide optimal treatment, such as radiotherapy and chemotherapy.
DNACPR facts
- not legal doc - record of decision
- gives guidance to clinicians of those who don’t know the patient
- Document decision in notes - if no capacity needs to be with family
Guidance of DNACPR (3)
- Patients must be made aware of DNACPR form
UNLESS - ‘psychological or physical harm’ - Must inform those close to the patient, without delay
- When there is clinical certainty DNACPR will remain in place
Withdrawl of treatment - capacity
patient’s legal and ethical right to decide to refuse treatment.
If the patient has capacity, this decision must be respected and complied with, even if this may lead to death.
Continuing unwanted treatment is battery and is a criminal offence.
Communication is key.
Planning and preparation.
When a treatment is started, patients should understand it can be withdrawn if they no longer want it.
Symptoms should be anticipated and managed effectively.
Withdrawing treatment - no capacity
treat patients best interests
- however there is no obligation to prolong life irrespective of the quality of that life or of the patient’s own views.
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