Ethics: Control of Pain Flashcards
What is palliative care?
- ‘To cloak’
- Medical care that concentrates on reducing severity of symptoms rather than trying to provide a cure or halt the progression of disease.
- An approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering.
Why is beginning palliative care so problematic?
- May cause anxiety + anger
- Doctors often feel that it is akin to ‘failure’ - but the doctor’s role is not always to cure.
- Fostering and respecting patients’ autonomy is key
Is the decision to begin palliation based on futility (ie. on the basis that further treatment simply will not work)?
No - not always, instead the decision is often based on a value judgement that further curative treatment is not in the best interests of the patient.
What are the components of a ‘good death’?
- Pain + symptom management
- Clear decision-making
- Preparation for death
- Completion
- Contributing to others
- Affirmation of the whole person
What is active and passive euthanasia?
- Active: where a person deliberately intervenes to end someone’s life eg. inject them w/ sedatives
- Passive: where a person causes death by withholding or withdrawing treatment that is necessary to maintain life, eg. witholding antibiotics in someone with pneumonia.
What is the difference between voluntary, involuntary and non-voluntary euthanasia?
- Voluntary - where a person makes a conscious decision to die + asks for help to do this
- Involuntary - where a person is killed against their expressed wishes
- Non-voluntary - where a person is unable to give their consent (eg coma) and another person takes decision on their behalf often bc ill person prev expressed a wish to die in circumstances
Is suicide unlawful? What about assisted suicide?
Suicide itself is not unlawful, however assisted suicide is unlawful.
What is death tourism?
When families have accompanied relatives to places like Dignitas for the administration of barbituraes or where assisted euthanasia is legal
The DPP guidance lists factors that weigh in favour of and against prosecution following an investigation. What are the factors that will weigh in favour of prosecution (so against assisted euthanasia)?
- Under 18
- Questions about capacity
- No clear, settled and informed wish to die
- Equivocal about dying
- Process not initiated by person who dies
- No terminal illness, severe and incurable physical disability or severe degenerative disease
- Not motivated by compassion (or motivated by gain)
- Evidence of persuasian, coersion, undue influence or pressure
What are the factors that will weigh against prosecution (so for assisted euthanasia)?
- A clear, settled, informed wish to die
- Unequivocal and consistent about dying
- Process was initiated by person who died
- Person had terminal illness etc + no recovery
- Evidence -> motivated solely by compassion
- Person offering assistance = spouse, partner, close relative or friend
- Assistance provided was minor
Even though euthanasia is illegal, what does the law respect distinctions between?
- Active commisions and passive omissions
- Intention and foresight
Confusing as omission sounds like passive euthanasia.
What is Doctrine of Double effect?
This doctrine says that if doing something morally good has a morally bad side-effect it’s ethically OK to do it providing the bad side-effect wasn’t intended. This is true even if you foresaw that the bad effect would probably happen.
What do proponents and opponents of the doctrine (DDE) argue?
Proponents argue that principle captures important notion of intentions but opponents argue the consequences are all the same: death - the intentions do not matter.
What is an act and what is an omission?
Act = to carry out a medical intervention
Omission = to withold medical intervention
