End of Life, Ethics and Legal Guidelines Regarding Nutritional Support Flashcards
A 16 year old girl has a neurological disorder. She is deemed to have capacity, so is she able to make decisions on her own behalf?
- yes
> 16 years old are deemed as adults
Even if <16, but understands risks vs benefits, based on Gillick competency she could still make decisions on her own
A 16 year old girl has a neurological disorder. If she refuses PEG treatment, are her parents able to overrule her decision?
- yes
16-17 years olds can be overridden by parents or courts
52 year old man has an accident and suffers severe head injury and remains unresponsive, and is diagnosed as a persistent vegetative state. The patient has a witnessed and signed advanced directive from when he was 30, stating he wants all forms of treatment to keep him alive.
Is the witnessed and signed advanced directive valid here?
- no
Patients can refuse treatment, but not demand treatment.
The advanced directive is also very old, so would be checked
A patient has been in a vegetative state for 3 months, is this sufficient to diagnose a patients as being in a permanent vegetative state?
- No
Royal college of physicians state the following:
- > 6 months following anoxic or other metabolic brain injury
1 year following traumatic brain injury
If a patient has been diagnosed as being in a persistent vegetative state, is the decision to withdraw artificial nutrition and hydration just a clinical decision?
- no
Clinical, family and trust lawyer decision
Man diagnosed with dementia 4 years ago presents to hospital with a chest infection. No family but has a friend who has enduring power of attorney due to his dementia. His BMI is 19 and he is not drinking or eating well. Should a capacity act be performed?
- yes
Regardless of the dementia, at the time of the consultation he may be placid
Man diagnosed with dementia 4 years ago presents to hospital with a chest infection. No family but has a friend who has enduring power of attorney due to his dementia. Is the friend able to give consent to tube feed the patient?
- No
Enduring power of attorney relates to property and affairs and NOT health
Should patients with terminal dementia be PEG fed if they are not eating and drinking and losing weight?
- No
No evidence to show it benefits health and quality of life
63 year old patient with previous hemicolectomy due to cecal carcinoma presents with presents with obstruction and evidence of peritoneal metastases and has not fed for 7 days. Should she be referred to the palliative care team?
- Yes
Which of the following is NOT one of the 4 pillars of medicine?
1 - Respect for autonomy
2 - Beneficence
3 - Respect
4 - Non-maleficence (do no harm)
5 - Justice
3 - Respect
Beneficence is defined as an act of charity, mercy, and kindness with a strong connotation of doing good to others including moral obligation.
Which of the following is NOT routinely performed when confirming the death of a patient?
1 - check central pulse on palpation (carotids)
2 - heart sounds on auscultation
3 - respiratory sounds on auscultation
4 - reflexes and muscle tone
5 - signs of life (e.g. movement and respiratory effort)
4 - reflexes and muscle tone
This all needs to be documents in the patients notes
When confirming the death of a patient through assessing:
- central pulse on palpation (carotid artery)
- heart sounds on auscultation
- respiratory sounds on auscultation
- signs of life (e.g. movement and respiratory effort)
How long should this be performed for to confirm death?
1 - 30 seconds and multiply by 2
2 - 1 minute and multiply by 5
3 - 5 minutes
4 - 10 minutes
3 - 5 minutes
This all needs to be documents in the patients notes
Which of the following should be performed on the patients eyes to confirm the death of a patient?
1 - corneal reflex
2 - eye movements
3 - pupillary response
4 - absence of motor response following supraorbital pressure
3 - pupillary response
Others are not routinely performed
