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Medicine Year 1 - Semester 2 - Part 1 > Ethics at the End of Life > Flashcards

Ethics at the End of Life Flashcards

1
Q

Why might people not want to discuss death ?

A

Discomfort
Distance
Disputes
Regrets

Disbelief in diagnosis
Disinterested
Misplaced hope in medicine

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2
Q

What is palliative care ?

A

Care at the end of life

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3
Q

Concept of palliative care

A

A concept where there is a shift of emphasis from conventional care that focuses on the quantity of life, towards a commitment to care that enhances the quality of life.

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4
Q

Who founded the hospice movement ?

A

Cicely Saunders

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5
Q

Values of the hospice movement

A

The focus of care in the hospice is based on a HOLISTIC view of the person :

  • Physical
  • Emotional
  • Psychological
  • Spiritual
  • Social

Often a focus on pain management

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6
Q

Ethical Principles for the end of life

A

Respect for autonomy
Beneficence
Non-maleficence
Justice

Law and Sanctity of life

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7
Q

Euthanasia

A

X intentionally kills Y, or permits Y’s death for Y’s benefit

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8
Q

Active euthanasia

A

X performs an action which itself results in Y’s death

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9
Q

Passive Euthanasia

A

X allows Y to die.

X withholds life prolonging treatment or withdraws life-prolonging treatment.

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10
Q

Voluntary euthanasia

A

Euthanasia when Y competently requests death himself

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11
Q

Non-voluntary euthanasia

A

Euthanasia when Y is not competent to express a preference.

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12
Q

Involuntary euthanasia

A

Death is against Y’s competent wishes, although X permits or imposes death for Y’s benefit.

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13
Q

Suicide

A

Y intentionally kills himself

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14
Q

Assisted suicide

A

X intentionally helps Y to kill himself

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15
Q

Murder

A

X intentionally kills Y

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16
Q

What is euthanasia ?

A

The act of deliberately ending a persons life to relieve suffering.

17
Q

R v Cox 1992
Active Euthanasia

A

Lillian Boyes , 70 years old, severe rheumatoid arthritis

Pain beyond reach of analgesics
Expected to die within days / weeks
Asked Dr Cox to kill her

Dr Cox injected a lethal dose of potassium chloride.

Charged with attempted murder
Found guilty of attempted murder.

18
Q

Tony Bland
Passive Euthanasia
Airedale NHS Trust v Bland, 1993

A

1989, 21 years old, Anthony Bland

Crushed by overcrowding at football stadium.

Attempts to resuscitate resulted in him being permanently unconscious (permanent/persistent vegetative state)

After 3 years, Hospital trust applied to court ruling whether it would be lawful to discontinue life support.

Doctor and parents wanted to stop feeding and antibiotics.

Application was opposed by official solicitor representing Tony.

Case went to House of Lords.
Life-support was allowed to be turned off.

19
Q

Daniel James
Voluntary Euthanasia

A

Daniel James, 23, seriously injured at rugby incident and paralysed.

Died at Dignitas 2008, accompanied by parents.

Enough evidence existed to prosecute Daniel’s parents and a family friend.

DPP decided is was not in public interest to prosecute Daniels parents and family friend.

20
Q

Case of Diane Pretty

R v Director of Public Prosecutions, 2001

A

Diane suffered motor neurone disease

Mrs Pretty’s husband was willing to help her commit suicide, but the couple was anxious he would be prosecuted.

She asked DPP to give undertaking that he shouldn’t consent to Mr Pretty’s prosecution.

She dies 12 days after her appeal was rejected by the ECtHR.

21
Q

IN the UK what assisted dying is acceptable ?

A

Passive is acceptable, Active is not.

22
Q

Smith and Jones

A

Acts vs Omissions

23
Q

Robinson and Davies

A

Acts vs Omissions

24
Q

Doctrine of Double Effect

A

You cannot give a drug with the intention to kill another person.

However, increasing doses of painkiller can be given to alleviate pain, with the possibility of death.

Distinction between intending death and foreseeing death.

25
Q

Some reasons for allowing active euthanasia

A

Consistency
From passive to active
(allow passive so allow active)

From painkillers to lethal injections
(allow painkillers so allow lethal injections)

Appeal to principles : autonomy and beneficence

Benefits of regulation

26
Q

Some reasons against allowing euthanasia

A

Respect for sanctity of life
Palliative care
Exploitation / manipulation
Contrary to aims of medicine
Slippery Slope

27
Q

When is euthanasia allowed in The Netherlands ?

A

If :

  • patient is incurably ill
  • patient is experiencing unbearable suffering
  • patient has requested his/her life to be terminated
  • termination is performed by the patients own doctor
28
Q

3 Key points of euthanasia in The Netherlands

A

Advance directives are allowed

Children >12 years old can request euthanasia

Euthanasia of severely disabled newborns is allowed

29
Q

Describe laws surrounding ending of life in Switzerland

A

Assisted suicide is legally condoned

Assisting someone to commit suicide is illegal ONLY if the motive is selfish.

Persons assisting doesn’t have to be a physician, person doesn’t need to reside in Switzerland

30
Q

Organisations in Switzerland

A

EXIT
Dignitas

31
Q

Ending of life in - Oregon USA

A

Physician assisted suicide is legal in Oregon - not euthanasia

Death with dignity act 1994

Only applies to residents of Oregon

IN PAS, the doctor provides the medicine but does not administer

32
Q

Other places where euthanasia is legal

A

Belgium - 2002
Canada - 2015 - permits nurses to end patients lives

33
Q

Scotland laws around euthanasia

A

Assisted death illegal

34
Q

Describe organ donation in the UK

A

UK is moving away from an opt-in system

Do not allow directed/conditional donation

What factors determine who gets the organs ?

35
Q

Reasons why potential donors don’t become actual donors

A

Tests for brainstem death not carried out

Refusal by relatives

Medical contradictions to donation

Relatives not asked about donation

Heart stopped beating before brainstem death complete

Organs offered but not retrieved

Medicine Year 1 - Semester 2 - Part 1 (51 decks)

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