Ethical Challenges in Palliative Care Nursing

Question 1

The “in-between” Moral Dilemmas of nurses:

Answer 1

• High responsibilty with a disproportionately low level of control/ authority over decisions which giiving rise to “in-between” moral distress and moral outrage
• Traumatization: deep personal preoccupation, lost sleep, anger, dissilusionment
• Generally Silent.

Question 2

Principlism: Principles of Biomedical Ethics

Answer 2

• Autonomy (right to self-determination)
• Beneficence (promote good)
• Nonmaleficence (to not seek to inflict harm)
• Justice (fairness–> need, equality, utility, liberty, restitution)

Question 3

Consent:

Answer 3

1. Self-determination(free/informed consent)
2. Substituted Judgement (Subtituted Judgment Standard OR Pure Autonomy Standard OR Best interest Standard (benefit vs burden))

Question 4

Competence vs capacity:

Answer 4

Competence is a LEGAL designation (legal competence and factual competence)
Capacity is a functional designation, episodic.

Question 5

Capacity to consent: 3 criterias

Answer 5

1. Based in understanding (condition, nature and purpose of tx, risk of tx and non-tx)
2. Intentional (manipulation of information)
3. Non-coerced (no manipulation, no persuasion)

Question 6

Surrogate decision-making when:

Answer 6

the person incapable to give consent to care, consent giving by his or her mandatary, tutor or curator.

Question 7

Exceptions for parental consent/permission:

Answer 7

• Mature minor (sufficient maturity to consent)
• Emancipated minor
• Emergency tx
• Court ordered tx

Question 8

Maturity and moral reasoning:

Answer 8

-Age and developmental stages do not necessarily determine cognitive and executive ability.

Question 9

Preschool children vs primary school children vs adolescents difference in maturity and reasoning capacity:

Answer 9

Preschool: No decision-making capacity
Primary school children: Do not have full capacity but should have involvement and opportunity for assent
Adolescents: can have the capacity but must be assessed on an individual basis.

Question 10

“End of Life” Measures: the principle of double effect

Answer 10

• Action itself must be morally indifferent or morally good
• the bad effect must not be the means by which the good effect is archieved.
• The motive must be the archievement of the good effect
• The good effect must be at least equivalent in importance to the bad effect.

Question 11

Is it legally and/or ethically permissible to whitdrawing or withholding artificial nutrition and hydratation in children?

Answer 11

BOTH legally and ethically permissible

Question 12

Epistemological relativism do NOT entail Moral relativism

Answer 12

the investigation of what distinguishes justified belief from opinion do not entail our own morality.

Question 13

Improving cross-cultural understanding: What to do about ethical disagreements?

Answer 13

CULTURAL BROKERAGE: the act of bridging, linking or mediating between groups or persons of different cultural backgrounds for the purpose of reducing conflict or producing change.

Question 14

Culturally sensitive care is a continuum on thinking about p/f and clinical team with regards to diversity. 3 differents approaches:

Answer 14

• Explanatory phenomenon: Culture is reified
• Humanist view: Differences are contextualized; complex understanding of diversity’ cultural humility
• Universalist approach: otherness is overshadowed by sameness; separate the biological, soclal, cultural.

Question 15

Ethical problem in End of life and palliative care:

Answer 15

Inadequate pain management***

Question 16

Key features of Bill 52:

Answer 16

NO PEDIATRIC EXCLUSION

1. Explicitly recognizes right to end of lide care
2. Explicitly recognizes the “legality” of palliative sedation (Continuous palliative sedation)
3. Legalize advance medical directives (only age of majority)
4. Legalize medical aid in dying (only age of majority)