Ethics at the End of Life

Question 1

What are the characteristics of a good death?

Answer 1

Communication (patient, carers /relatives, healthcare team)
Symptoms well controlled
Not distressing
Time to plan
Preferred place of death

Question 2

What are the characteristics of a bad death?

Answer 2

Poor communication
Perception of failure of healthcare team
Distressing symptoms
Sudden
Catastrophic event, e.g. bleed
No time to plan ahead or achieve goals
Disagreement

Question 3

How can quality of life at the end of life be enhanced?

Answer 3

Caring attitude of staff
Family visits
Physical environment
Maintaining control
Feeling safe/ not alone
Art sessions

Question 4

What factors have a negative impact of quality of life at the end of life?

Answer 4

Lost independence
Lost activities
Pain/ fear of pain
Feeling a burden

Question 5

What is collusion?

Answer 5

Collusion refers to a secret agreement made between clinicians and family members to hide the diagnosis of a serious or life-threatening illness from the patient

Question 6

What are the common reasons for collusion?

Answer 6

Disclosure causes the patient to lose hope
Disclosure leads to depression
Disclosure hastens the progression of the illness and death
Disclosure increases the risk of patient suicide
Disclosure may cause psychological pain for the patient
Family members themselves may not be aware of the nature and severity of the illness
Family members may be in denial
Family members may be in conflict

Question 7

Why does collusion go against the principles of best medical practice?

Answer 7

Collusion is at odds patient autonomy and to the right to self-determination.
Revealing the diagnosis to relatives before revealing it to patients breaches patients’ right to medical confidentiality.
Patients are unable to give informed consent if they are not aware of the underlying illness and thus may not obtain appropriate or optimum and timely treatment.
Collusion results in a breakdown of the clinician–patient relationship and a loss of trust between patients and clinicians

Question 8

When is it medically acceptable to let a patient die?

Answer 8

1. Medical technology is useless

2. Patients validly refuse a medical technology

Question 9

What is the difference between euthanasia and physician assisted suicide?

Answer 9

Euthanasia is the act of deliberately ending a person’s life to relieve suffering, e.g. a doctor administering a lethal cocktail of drugs explicitly to end a life. Physician assisted suicide involves prescribing lethal drugs intended explicitly to end a life. The person takes the mediations themselves or is assisted in some way to take them

Question 10

What are the arguments in support of euthanasia/physician assisted suicide?

Answer 10

Suicide is legal. Those who are so disabled they cannot take their own life are disadvantaged.
Withdrawing and withholding life-prolonging treatment is widely accepted and practised.
The suffering associated with some diseases outweighs the benefits of continuing to live.
Respect for patient autonomy

Question 11

What are the arguments against authanasia/physician assisted suicide?

Answer 11

Good palliative care obviates the need for PAS.
Discourages palliative care research.
Vulnerable patients are at risk – coercion, feeling like a burden, free up medical resources.
Slippery slope - may lead to involuntary euthanasia for people deemed ‘undesirable’.
Affects other people’s rights, not just the patient.
Contrary to the aims of medicine – promotion of health and life. Patients may lose trust.