ETHICS IN AGING AND END OF LIFE CARE Flashcards
two most commonly used types of advanced diirectives ?
living wills
health care proxy
what is the difference between a living will and a health proxy ?
living will : instructions about particular kinds of treatment or interventions
health-care proxy : a designated individual who is trusted by the patient
autonomy ?
right of self goveernment
justice ?
obligation to be fair to everyone - healthcare for all
beneficence ?
do good to the patient
non-maleficence ?
protect patient from harm
this especially applies to children and the elderly
veracity ?
to be honest and trustworthy
what is substituted judgement standard ?
decision made for an individual when the surrogate decision maker knows what the patient would want
what is best interest standard ?
decision made about an individual patient’s health when the patient is unable to make it themselves
substituted judgement standard vs best interest standard ?
The key question under best interests is, “What do you think is best for your mother?” Under substituted judgment it is, “What would your mother choose if she could tell us?”
laws regarding euthanasia in the arab world ?
prohibited in the arab world
what is passive euthanasia ?
intentionally letting a patient die by withholding artificial life support such as a ventilator or feeding tube
what are the types of euthanasia ?
voluntary euthanasia - causing death for someone who wants to die ( patient is competent)
non voluntary euthanasia - causing death for someone who lacks capacity
involuntary euthanasia - causing death of a patient against their will
assistance in suicide ?
knowingly and intentionally providing a person with the knowledge or means or both required to commit suicide
what are the factors that must be fulfilled that are associated with permissible euthanasia ?
competent
incurable illness
voluntarily
no personal gain
what is futile treatment ?
any treatment that, within a reasonable degree of medical certainty, is seen to be without benefit to the patient
treatment malhoosh lazma
purpose of DNR ?
refusing artificial support
avoid futile treatment
when is psychiatric consultation necessary in end of life treatment decisions ?
only if the patient’s capacity to understand is uncertain
what triad is associated with thee definition of death ?
triad of bichat
irreversible loss of circulation
respiration
innervation (brain death )
what is the difference between somatic and molecular death ?
somatic death eventually becomes molecular death
what are the conditions that stop a death from being classified as a natural death ?
suspicion of accident
homicide
or suicide
when should life support be switched off ?
must not be switched off as long as brain stem death is not legalized
how to confirm clinical death ?
circulation:
- no pulses
- no blood pressure reading
- flat ECG
respiration :
- apnea
- ABG severe hypoxia and hypercapnia
CNS:
- deep unresponsive coma
- absence of any movement
- flat EEG
- no reflexes
clinical evaluation of brain death ?
absence or corneal reflex
absence of pupillary response
absence of gag reflex
absence of oculovestibular response
what ddoess the doll’s eeyee phenomenon describe ?
absence of oculocephalic response
brain death should be confirmed by :
1- three separate medical experts
2- not including anyone from the transplant team
3- perform examination twice 24 hours apart
what are the conditions for living donors :
1- the donor should be medically fit
2- should be a relative up to the 4th degree
3- egyptians cant donate to none egyptians except after 3 years of marriage
4- informed consent from the donor
what is persistent vegetative state ?
loss of higher cerebral powers
whilst still maintaining the function of the brainstem
clinical presentation of persistent vegetative state ?
1- cyclic state of circadian sleep and wake
2- heads and eyes can follow a moving object or move towards a loud sound
what is suspended animation / apparent death ?
the temporary cessation of most vital functions without death
seen in electrocution, massive doses of CNS depressants and yoga practitioners
true or false brain death is a legal definition in Egypt
false
A 35-year-old woman is admitted after having a seizure at a party.Her head CT scan shows an intracranial bleed. She is intubated because of loss of spontaneous respiration.
There are no pupillary, corneal, oculocephalic or cold caloric reflexes elicited.
what investigation should be done next ?
urine toxicology screen