Ethics at the end of life Flashcards
What are the reasons people may not want to discuss death?
- Discomfort
- Distance
- Disputes
- Regrets
- Disbelief
- Disinterest
- Misplaced hope
These reasons can affect healthcare decisions and the willingness to engage in end-of-life planning.
What is the hospice movement?
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.
Who founded the first purpose-built hospice in the UK?
Cicely Saunders founded St Christopher’s Hospice in 1967.
What is the shift in emphasis of the hospice movement?
From conventional care focusing on quantity of life to care enhancing quality of life.
What does ‘total pain’ refer to in palliative care?
A concept that includes physical, emotional, psychological, spiritual, and social pain.
What percentage of people died in a hospice in England in 2022?
4.7%
What ethical principles guide medical decisions at the end of life?
- Respect for autonomy
- Beneficence
- Non-maleficence
- Justice
These principles are essential in making ethical healthcare decisions.
Define active euthanasia.
X performs an action which itself results in Y’s death.
Define passive euthanasia.
X allows Y to die by withholding or withdrawing life-prolonging treatment.
What is voluntary euthanasia?
Euthanasia when Y competently requests death themselves.
What is non-voluntary euthanasia?
Euthanasia when Y is not competent to express a preference.
What is involuntary euthanasia?
Death is against Y’s competent wishes, although X permits or imposes death for Y’s benefit.
What is the difference between assisted suicide and euthanasia?
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.
What was the outcome of the case R v Cox (1992)?
Dr. Cox was found guilty of attempted murder for injecting a patient at her request.
What was the legal significance of the case Airedale NHS Trust v Bland (1993)?
It addressed the legality of discontinuing life support for a patient in a persistent vegetative state.
What is the doctrine of double effect?
A principle that allows for actions that have both good and bad effects, provided the intention is to achieve the good effect.
What are the five questions to ask at life’s end according to Atul Gawande?
- 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.
What is the role of palliative care experts in hospitals?
To improve the experience of dying patients in hospitals and provide better end-of-life care.
True or False: Most physicians would prefer aggressive treatment for themselves.
False
Fill in the blank: Euthanasia is the act of deliberately _______ a person’s life to relieve suffering.
ending
What ethical considerations are present in end-of-life decisions?
Law and sanctity of life.
What does the term ‘suicide’ refer to?
Y intentionally kills himself.
What was the decision of the DPP regarding Daniel James’s case?
There was enough evidence to prosecute but the DPP decided not to prosecute.
What happened to Daniel James in 2008?
He died by suicide at the Dignitas clinic in Switzerland after being paralyzed from a rugby accident.
Daniel was accompanied by his parents during this event.
What was the DPP’s decision regarding the prosecution of Daniel’s parents?
The DPP decided it was not in the public interest to prosecute.
The DPP exercises discretion retrospectively after reviewing all facts of the police investigation.
What terminal illness did Dianne Pretty suffer from?
Motor neurone disease, which is a progressive and degenerative terminal illness.
Patients retain their mental faculties while their body fails.
What did Mrs. Pretty request from the DPP?
She requested an undertaking that her husband would not be prosecuted for assisting her suicide.
This was under the Suicide Act, 1961.
What is the difference between passive and active euthanasia?
Passive euthanasia is acceptable while active euthanasia is not.
This distinction raises ethical questions regarding acts vs omissions.
In the case of Smith and Jones, what was Smith’s action?
Smith drowned his cousin to inherit money, arranging it to look like an accident.
He had the intention to kill for personal gain.
What was Jones’s situation in the case of Smith and Jones?
Jones’s cousin accidentally drowned while Jones stood ready to push him back under the water.
Jones could have saved his cousin but did not.
What was Robinson’s action that led to someone’s death?
Robinson did not donate £100 to charity, resulting in one death from starvation.
This highlights the ethical implications of omission.
What did Davies do that resulted in both saving and killing someone?
Davies sent £100 to charity but also included a poisoned food parcel, resulting in one death and one life saved.
This illustrates the complexity of intentions in ethical decisions.
What is the doctrine of double effect (DDE)?
It allows for pain relief that may foreseeably cause death, distinguishing between intending and foreseeing death.
This is ethically significant in medical practice.
What are some reasons for allowing active euthanasia?
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
These reasons reflect complex ethical considerations.
What are the conditions under which euthanasia is allowed in the Netherlands?
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.
Advance directives for euthanasia are permitted.
What is the legal status of assisted suicide in Switzerland?
Assisted suicide is legally condoned if the motive is unselfish.
Organizations like EXIT and Dignitas assist with this process.
What is the Death with Dignity Act?
It allows physician-assisted suicide in Oregon, permitting doctors to prescribe lethal medication for voluntary self-administration by patients.
Euthanasia remains illegal in the US.
What recent changes have occurred in organ donation systems in the UK?
The UK has shifted from ‘opt-in’ to ‘opt-out’ systems for organ donation.
This includes ‘deemed consent’ in Wales and ‘deemed authorisation’ in Scotland.
What factors determine who gets the organs in organ donation?
Factors include:
* Compatibility
* Age
* Proximity to transplant center.
Ethical issues surrounding organ donation systems are complex.
What are some reasons potential donors do not become actual donors?
Reasons include:
* Tests for brainstem death not carried out
* Refusal by relatives
* Medical contraindications
* Not asked about donation
* Organs offered but not retrieved.
This highlights systemic issues in organ donation processes.
What are the learning outcomes of the MD2002 Ethics at the end of life course?
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.
These outcomes aim to provide a comprehensive understanding of ethical issues.
