Ethics Flashcards
T or F: Withdrawal of care must always be proven brain death.
False
- i.e. 7 y.o. CP with MVA presents GCS 4. ICU x 1 week with no change. if parents certain to withdraw they can.
Jehovah’s witness need emergent blood. What do you do?
Transfuse now without parental consent.
What are exceptions to general duty to provide life-sustaining tx?
- No Tx.
- Tx harmful.
- Going to die fast.
- Withdrawal better palliation.
Details:
- distress or suffering cannot be prevented or alleviated
- tx clearly ineffective or harmful
- irreversible progression to imminent death
- life to be severely shortened regardless of tx; withdrawal or limited care provide better palliation
T or F: withhold or withdraw life-sustaining tx ethically appropriate if tx will not benefit child or adolescent.
True
Tips with withdrawal or withholding care:
- interdisciplinary team involved +/- ethics committee or consultant
- recognize cultural, religious, spiritual, moral bkgrd of families
- document + review well decision well
Management decisions should ALWAYS be based on:
best interest of child
NOT:
- cost to society
- burden to fam
T or F: Autonomy may be superseded with CAS if child apprehended.
True.
- CAS authority can supersede wishes of parent + child if apprehended.
T or F: tx decision from proxy decision makers cannot change once made.
False.
What is a substitute decision maker?
- guardian respect child’s previously expressed wishes
What is a proxy decision maker?
= decision makers if pt incapable
- two types:
> substitute= know well and already discussed what they want done
>surrogate= don’t know but decide in best interest
List 3 Hallmarks of Informed Choice
“VIC”
- VOLUNTARIness (no manipulation or coercion)
- Appropriate INFO
- CAPACITY
What is assent?
Info they can understand and appropriate choice of tx.
- i.e. which arm to poke for BW
- best for kids w/ partial skills to make decision
What’s the difference between emancipated versus mature minors?
Emancipated: no longer dependent on parent.
Mature= irregardless of age can understand health condition and tx
If you think parental decision not in best interest of child- what do you do?
- explore decision w/ multi-D
- 2nd opinion.
- ethics committee or consultant
- or if all consultants agree contrary then legal opinion
T or F: there is minimum age for decision making?
False.
Brain death =
irreversible cessation of entire brain (inclding brainstem)
AKA determination of death using neuro criteria
Brain death is most commonly after:
- TBI
2. Asphyxia injury
What are the 3 clinical components of brain death:
- Irreversible coma with known cause
- not metabolic, toxin, drugs, T, lytes etc. - Absence of brainstem reflexes
- pupillary light, oculocephalic, corneal, oculovestibular, gag + cough - Apnea
- no resp effort after adequate stimulus
+ observation period x 2 examinations (12-24h)
T or F: spinal reflexes may occur in brain death
True.
- subtle, semi-rhythmic movement of facial nerve, finger flexion, tonic neck etc.
What is the apnea test in brain death?
Goal: assess function of medulla in driving vent
1- ensure no other reason for apnea (i.e. sedative drugs, metabolic)
2- pre-O2 100%
3- vent adjusted to get PCO2 40
4- baseline gas
5- repeated blood gas till target PCO2 suppressed (60) or unstable
Are EEG and Cerebral blood flow required for brain death dx?
No.
Ancillary test.
- may do if can’t do apnea test well
+ help shorten observation period
Most kids on peds organ donation waiting for:
liver
kidney
small bowel
T or F: anyone can approach families about organ donation
False.
- AAP: approach in systematic person trained in psych, social, medial part of dx
Who can be considered for organ donation?
- declared brain death
- cardiocirculatory death
