Ethics at the End of Life

Question 1

Name the 4 ethical principles/pillars.

Answer 1

Respect for Autonomy
Beneficence
Non-maleficience
Justice

Question 2

Using Xs & Ys, define euthanasia.

Answer 2

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

Question 3

Using Xs & Ys, define active euthanasia.

Answer 3

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

Question 4

Using Xs & Ys, define passive euthanasia.

Answer 4

X allows Y to die by withholding/withdrawing life prolonging treatment

Question 5

Using Xs & Ys, define voluntary euthanasia.

Answer 5

Euthanasia when Y competently requests death himself

Question 6

Using Xs & Ys, define non-voluntary euthanasia.

Answer 6

Euthanasia when Y is not competent to express a preference

Question 7

Using Xs & Ys, define involuntary euthanasia.

Answer 7

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

Question 8

Using Xs & Ys, define suicide.

Answer 8

Y intentionally kills himself

Question 9

Using Xs & Ys, define assisted suicide.

Answer 9

X intentionally helps Y to kill himself

Question 10

Using Xs & Ys, define murder.

Answer 10

X intentionally kills Y

Question 11

What is the Doctrine of Double Effect (DDE)?

Answer 11

Increasing doses of painkiller given to alleviate pain, but carries the possibility of causing death

Question 12

List some reasons for allowing euthanasia.

Answer 12

Consistency (suicide is legal…)
Passive vs Active (passive = slow death)
Painkillers to lethal injections (DDE is allowed)
Appeal to principles: Autonomy & Beneficence - mercy shown
Benefits of regulation (policing occurs & doctors less vulnerable)

Question 13

List some reasons against allowing euthanasia.

Answer 13

Respect for sanctity of life (isn’t all life valuable?)
Palliative care (reasons patients give)
Potential for exploitation/manipulation
Contrary to aims of medicine (doctor/patient relationship)
Slippery slope (voluntary —> involuntary)

Question 14

In the Netherlands, when is euthanasia permitted?

Answer 14

If incurably ill
If suffering is unbearable
If it is the patient’s request
If the termination is performed by the patient’s own doctor

Question 15

In the Netherlands, can euthanasia be carried out if the patient is incompetent to consent?

Answer 15

Advance directives are allowed, therefore a surrogate decision maker can gain lasting power of attorney, if aforementioned in the person’s will

Question 16

What is the age limit for requesting euthanasia in the Netherlands?

Answer 16

12 years old

Question 17

Are there any exceptional circumstances in which euthanasia is allowed under the age limit in the Netherlands?

Answer 17

Yes, euthanasia of severely disabled newborns is allowed

Question 18

Is euthanasia legal in Switzerland?

Answer 18

Yes, it is condoned/accepted

Question 19

Is assisted suicide legal in Switzerland?

Answer 19

Yes, but the motive must be unselfish - otherwise it is illegal

Question 20

Name two Swiss organisations which help people to die.

Answer 20

EXIT

Dignitas

Question 21

What is the ruling on euthanasia and assisted suicide in Oregon, USA?

Answer 21

Euthanasia: illegal (as with the entire US)

Physician assisted suicide: legal (only applies to residents of Oregon)

Question 22

What is the concept behind the 1967 hospice movement?

Answer 22

A holistic view of the person focusing on pain management - i.e. QUALITY of life as opposed to QUANTITY of life

Question 23

What system is in place regarding organ donation in the UK (bar Wales) and what type of consent is given if organs are donated?

Answer 23

Opt-in

Expressed consent

Question 24

What system is in place regarding organ donation in Wales and what type of consent is given if organs are donated?

Answer 24

Opt-out

Deemed consent

Question 25

List a few reasons why potential donors don’t become actual donors.

Answer 25

Refusal by relatives
Organs offered, but not retrieved
Heat stopped beating before brainstem death complete
Medical contraindication to donation (i.e. organs refused)
Relatives not asked about donation
Tests for brainstem death not carried out