Ethics at the end of life

Question 2

What are the reasons people may not want to discuss death?

Answer 2

• Discomfort
• Distance
• Disputes
• Regrets
• Disbelief
• Disinterest
• Misplaced hope

These reasons can affect healthcare decisions and the willingness to engage in end-of-life planning.

Question 3

What is the hospice movement?

Answer 3

A movement focused on providing palliative care that enhances the quality of life for terminally ill patients.

Pioneered by Cicely Saunders, the hospice movement emphasizes holistic care.

Question 4

Who founded the first purpose-built hospice in the UK?

Answer 4

Cicely Saunders founded St Christopher’s Hospice in 1967.

Question 5

What is the shift in emphasis of the hospice movement?

Answer 5

From conventional care focusing on quantity of life to care enhancing quality of life.

Question 6

What does ‘total pain’ refer to in palliative care?

Answer 6

A concept that includes physical, emotional, psychological, spiritual, and social pain.

Question 7

What percentage of people died in a hospice in England in 2022?

Answer 7

4.7%

Question 8

What ethical principles guide medical decisions at the end of life?

Answer 8

• Respect for autonomy
• Beneficence
• Non-maleficence
• Justice

These principles are essential in making ethical healthcare decisions.

Question 9

Define active euthanasia.

Answer 9

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

Question 10

Define passive euthanasia.

Answer 10

X allows Y to die by withholding or withdrawing life-prolonging treatment.

Question 11

What is voluntary euthanasia?

Answer 11

Euthanasia when Y competently requests death themselves.

Question 12

What is non-voluntary euthanasia?

Answer 12

Euthanasia when Y is not competent to express a preference.

Question 13

What is involuntary euthanasia?

Answer 13

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

Question 14

What is the difference between assisted suicide and euthanasia?

Answer 14

Assisted suicide involves X helping Y to kill himself, whereas euthanasia involves X intentionally killing Y or permitting Y’s death for Y’s benefit.

Question 15

What was the outcome of the case R v Cox (1992)?

Answer 15

Dr. Cox was found guilty of attempted murder for injecting a patient at her request.

Question 16

What was the legal significance of the case Airedale NHS Trust v Bland (1993)?

Answer 16

It addressed the legality of discontinuing life support for a patient in a persistent vegetative state.

Question 17

What is the doctrine of double effect?

Answer 17

A principle that allows for actions that have both good and bad effects, provided the intention is to achieve the good effect.

Question 18

What are the five questions to ask at life’s end according to Atul Gawande?

Answer 18

• Understanding of illness
• Fears or worries
• Goals and priorities
• Unacceptable outcomes
• Willingness to sacrifice

These questions help in understanding a patient’s wishes and values.

Question 19

What is the role of palliative care experts in hospitals?

Answer 19

To improve the experience of dying patients in hospitals and provide better end-of-life care.

Question 20

True or False: Most physicians would prefer aggressive treatment for themselves.

Answer 20

False

Question 21

Fill in the blank: Euthanasia is the act of deliberately _______ a person’s life to relieve suffering.

Answer 21

ending

Question 22

What ethical considerations are present in end-of-life decisions?

Answer 22

Law and sanctity of life.

Question 23

What does the term ‘suicide’ refer to?

Answer 23

Y intentionally kills himself.

Question 24

What was the decision of the DPP regarding Daniel James’s case?

Answer 24

There was enough evidence to prosecute but the DPP decided not to prosecute.

Question 25

What happened to Daniel James in 2008?

Answer 25

He died by suicide at the Dignitas clinic in Switzerland after being paralyzed from a rugby accident. ## Footnote Daniel was accompanied by his parents during this event.

Question 26

What was the DPP's decision regarding the prosecution of Daniel's parents?

Answer 26

The DPP decided it was not in the public interest to prosecute. ## Footnote The DPP exercises discretion retrospectively after reviewing all facts of the police investigation.

Question 27

What terminal illness did Dianne Pretty suffer from?

Answer 27

Motor neurone disease, which is a progressive and degenerative terminal illness. ## Footnote Patients retain their mental faculties while their body fails.

Question 28

What did Mrs. Pretty request from the DPP?

Answer 28

She requested an undertaking that her husband would not be prosecuted for assisting her suicide. ## Footnote This was under the Suicide Act, 1961.

Question 29

What is the difference between passive and active euthanasia?

Answer 29

Passive euthanasia is acceptable while active euthanasia is not. ## Footnote This distinction raises ethical questions regarding acts vs omissions.

Question 30

In the case of Smith and Jones, what was Smith's action?

Answer 30

Smith drowned his cousin to inherit money, arranging it to look like an accident. ## Footnote He had the intention to kill for personal gain.

Question 31

What was Jones's situation in the case of Smith and Jones?

Answer 31

Jones's cousin accidentally drowned while Jones stood ready to push him back under the water. ## Footnote Jones could have saved his cousin but did not.

Question 32

What was Robinson's action that led to someone's death?

Answer 32

Robinson did not donate £100 to charity, resulting in one death from starvation. ## Footnote This highlights the ethical implications of omission.

Question 33

What did Davies do that resulted in both saving and killing someone?

Answer 33

Davies sent £100 to charity but also included a poisoned food parcel, resulting in one death and one life saved. ## Footnote This illustrates the complexity of intentions in ethical decisions.

Question 34

What is the doctrine of double effect (DDE)?

Answer 34

It allows for pain relief that may foreseeably cause death, distinguishing between intending and foreseeing death. ## Footnote This is ethically significant in medical practice.

Question 35

What are some reasons for allowing active euthanasia?

Answer 35

Reasons include: * Consistency in treatment options * More honest approach * Appeal to autonomy and beneficence * Benefits of regulation * Respect for sanctity of life * Palliative care limitations * Risk of exploitation * Slippery slope concerns ## Footnote These reasons reflect complex ethical considerations.

Question 36

What are the conditions under which euthanasia is allowed in the Netherlands?

Answer 36

Euthanasia is allowed if: * Patient is incurably ill * Patient experiences unbearable suffering * Patient requests life termination * Termination is performed by the patient's own doctor. ## Footnote Advance directives for euthanasia are permitted.

Question 37

What is the legal status of assisted suicide in Switzerland?

Answer 37

Assisted suicide is legally condoned if the motive is unselfish. ## Footnote Organizations like EXIT and Dignitas assist with this process.

Question 38

What is the Death with Dignity Act?

Answer 38

It allows physician-assisted suicide in Oregon, permitting doctors to prescribe lethal medication for voluntary self-administration by patients. ## Footnote Euthanasia remains illegal in the US.

Question 39

What recent changes have occurred in organ donation systems in the UK?

Answer 39

The UK has shifted from 'opt-in' to 'opt-out' systems for organ donation. ## Footnote This includes 'deemed consent' in Wales and 'deemed authorisation' in Scotland.

Question 40

What factors determine who gets the organs in organ donation?

Answer 40

Factors include: * Compatibility * Age * Proximity to transplant center. ## Footnote Ethical issues surrounding organ donation systems are complex.

Question 41

What are some reasons potential donors do not become actual donors?

Answer 41

Reasons include: * Tests for brainstem death not carried out * Refusal by relatives * Medical contraindications * Not asked about donation * Organs offered but not retrieved. ## Footnote This highlights systemic issues in organ donation processes.

Question 42

What are the learning outcomes of the MD2002 Ethics at the end of life course?

Answer 42

Outcomes include: * Discussing reasons people avoid death discussions * Understanding palliative care * Identifying euthanasia categories * Explaining the doctrine of double effect * Reflecting on moral significance of actions * Awareness of euthanasia regulations in different regions * Explaining changes in organ donation arrangements. ## Footnote These outcomes aim to provide a comprehensive understanding of ethical issues.