Ethical decisions in palliative care Flashcards
What are the basic priniciples of ethical decision making?
1) Autonomy ((respect for the patient’s right to self-determination encompassing confidentiality)
2) Beneficence (the duty to ‘do good’)
3) Non-maleficence (the duty to ‘not do bad’)
4) To a lesser degree, justice (respect for the patients’ rights)
When does end of life care begins?
People are considered to be approaching the end of life when they are likely to die within the next 12 months, although this is not always possible to predict. This includes people whose death is imminent, as well as people who:
1) Have an advanced incurable illness, such as cancer, dementia or motor neurone disease.
2) Are generally frail and have co-existing conditions that mean they are expected to die within 12 months.
3) Have existing conditions if they are at risk of dying from a sudden crisis in their condition.
4) Have a life-threatening acute condition caused by a sudden catastrophic event, such as an accident or stroke.
Why is it important to identify people approaching the end of their life?
1) It is important to start discussions about advance care planning.
2) Gives them time to consider and re-evaluate their needs with their health and social care practitioners.
Which out of hours services is provided for palliative care patients?
Adults approaching the end of their life should have access to:
1) A healthcare professional available 24 hours a day, 7 days a week, who can access the person’s records and advance care plan and make informed decisions about changes to care.
2) An out of hours end of life care advice line.
3) An out of hours pharmacy service that has access to medicines for symptom management in adults approaching the end of their life.
Why is advance care plan important?
1) Offers people the opportunity to plan their future care and support, including medical treatment, while they have the capacity to do so.
2) Advance care plans are important to people at risk of losing mental capacity and people whose mental capacity varies at different times.
3) Provide information about their condition, the process of advance care plans, how they can change the decisions they have made while they still have capacity, how decisions will be made if they lose capacity.
4) Make sure you have up-to-date information about the person’s medical condition and treatment options to help the process and involve relevant healthcare staff if needed.
Which factors are important when developing advance care plans?
- Ask them if they want to involve their family, friends or advocates and if so, make sure they are included.
- Help them consider whether involving a healthcare professional could be useful.
- Take into account the person’s: History, social circumstances, wishes and feeling, beliefs, aspirations and any other factors they feel are important.
- Help them think about how their needs might change in the future.
Who provides palliative care?
1) Community and primary care services for adults, provided by the person’s GP in the primary or community care team.
2) Hospital services for adults whose treatment is based in secondary or tertiary care, provided by health and social care practitioners.
What is a palliative care meeting?
1) This is an opportunity to discuss anyone who is ‘approaching the end of life’.
2) These patients are recorded on a ‘palliative care register’ within the practice computer system.
3) Palliative care doesn’t refer to patients with cancer.
4) Allows the team to think ahead about how to provide high quality care in accordance with the patient’s wishes.
Important features about DNACPR
1) Part of end of life planning should include difficult decisions around resuscitation should be attempted and this decision should be clearly communicated to the OOH teams.
2) A copy of the DNAR form is kept with the patient, and also on their medical records, and the GP OOH services, and ambulance service are also informed about the form being in place.
3) DNAR forms should be considered indefinite unless the patient revokes the decision, a fixed review date is not recommended but it may be appropriate to review the decisions as clinical circumstances change.
Process of confirmation of death
Confirmation of birth is a task you need to perform as a doctor. You will need to check local policy regarding minimum timings, but an example of the process would be:
1) Wash hands.
2) Confirm the identity of the patients [if not known to you]
3) Inspection for any signs of life, any sign of respiration and any responsive verbal stimuli.
4) Pressure on fingernail to cheque for any response to pain.
5) Check pupils to ensure fixed and dilated.
6) Phil for carotid pulse for at least two minutes.
7) Listen for heart sounds for at least two minutes.
8) listen for respiratory sounds for at least three minutes.
9) Wash hands again and document findings and time of death as you have confirmed it.
