Ethical Decisions in Death and Dying- Dr. White Flashcards
Decisional Capacity
-Provider makes determination based on clinical examination that patient is able to make decisions for himself
Informed Consent
- Purpose is to promote autonomy in decision making
- Disclose information to help a patient make healthcare choices
3 Conditions of Informed Consent
- Pt is able to make a voluntary decision
- Pt has capacity to make medical decisions
- Pt is informed
Advanced Directives
- 2 types
1) Living will - Provides directions to physicians concerning the types of treatments/interventions the pt wants if they become incompetent
2) POLST paradigm program - Advance care planning to be completed with pt and health care professional
- Together with a patient or surrogate decision maker
In Hospital Sudden Cardiac Arrest (SCA)
- Several clinical factors have been identified that predict a greater likelihood of survival to hospital discharge
- Witnessed arrest
- VT of VF as initial rhythm
- Pulse regained during first 10min of CPR
Do Not Resuscitate (DNR) Orders
- No code or allow natural death (AND)
- Typically employed in patients who have failed multiple therapeutic interventions
- Main goal to avoid life sustaining measurers that would be futile or could cause harm in patient’s final days
- May include DNI
Problems with DNR Orders
- DNR discussions are often delayed until it is too late for the patient to participate in the decision
- Physicians do not provide adequate information to allow patients to make informed decisions
Role of Surrogate Decision Maker
- AKA healthcare proxy
- Usually named by patient
Withdrawing Care
- No more artificial hydration and nutrition
- Rapid death within minutes
- Death within hours to days
- Families should be informed about the steps involved and counseled about oxygen and medications for symptom support
What is Futility
- Serving no useful purpose; completely ineffective
- Intervention has no pathophysiological rationale
Chemotherapy at End of Life (EOL)
- Palliative considerations vs curative intent
- Can decrease the remaining quality of life or even shorten remaining survival time
Ethical issues Unique to Long Term Care
- Control and choices (autonomy)
- High rates of untreated pain
- Social and spiritual isolation
Euthanasia
-Means “good death”
Physician Aid in Dying
-Terminally ill patients determine to have capacity and ability to self administer oral medication
Lethal medication
- Prescription shall not be filled until 48hrs after it was written
- Secobarbital is commonly prescribed
- Phenobarbital and morphine are also used
