Ethics and Legal Issues at the End of Life

Question 1

How is death defined?

Answer 1

• Permanent loss of conscious awareness
• End of breathing and heart beat
• Permanent loss of brainstem functions (legal definition - irreversible coma with several brainstem components destroyed and no spontaneous breathing)
• End of all cellular functions and processes
• Desoulement

Question 2

List characteristics of human life

Answer 2

• Communication through language
• Relationships
• Complex emotions
• Personality
• Self consciousness
• Memory
• Moral reasoning
• Enjoyment/ fulfillment

Question 3

Describe the mental capacity act in relation to withdrawing treatment

Answer 3

• Must be made in best intrests of the person
• Decisions on withdrawing life support must never be motivated by a desire to bring about the patients death
• Where there is uncertainty, continue life sustaining treatment

Question 4

Compare substituted judgement and best interests

Answer 4

• Substituted judgement - what patients would have wanted if they had been competent. Previously expressed wishes of the patient. (Peoples opinions change however, and is it really the patients view?)
• Best interests - objective assessment of what is best for the patient given all the relevant circumstances (how do you weight different factors eg.chance of recovery?)

Question 5

Describe legal position on food and fluids

Answer 5

• Clinically assisted nutrition and hydration is regarded as medical treatment
• Oral fluids regarded as basic care
• Medical treatment eg. ANH can be withdrawn if continuing treatment is not in the patients best interests
• Basic care (oral fluids) should not be withdrawn

Question 6

What is the doctrine of double effect

Answer 6

• Doctors frequently harm patients as an unaffected side effect of treatment eg bone arrow transplant)
• It is always wrong to do something bad although good may result, but it is sometimes permissible to perform a good act though harm may result
• Rests on difference between what is intended and what is foreseen

Question 7

Describe the suicide act 1961

Answer 7

A person who aids, abets, counsels or procures the suicide of another, or an attempt by another to commit suicide shall be liable on conviction or indictment to imprisonment for a term not exceeding 14 years

Question 8

Burke v GMC 2005

Answer 8

• Patient said he did not want CANH withdrawn in the future when his condition (cerebral palsy) continued
• Doctors need to consider patients pre-expressed wishes and usually would continue feeding as a result