ETHICS IN AGING AND END OF LIFE CARE

Question 1

two most commonly used types of advanced diirectives ?

Answer 1

living wills
health care proxy

Question 2

what is the difference between a living will and a health proxy ?

Answer 2

living will : instructions about particular kinds of treatment or interventions
health-care proxy : a designated individual who is trusted by the patient

Question 3

autonomy ?

Answer 3

right of self goveernment

Question 4

justice ?

Answer 4

obligation to be fair to everyone - healthcare for all

Question 5

beneficence ?

Answer 5

do good to the patient

Question 6

non-maleficence ?

Answer 6

protect patient from harm
this especially applies to children and the elderly

Question 7

veracity ?

Answer 7

to be honest and trustworthy

Question 8

what is substituted judgement standard ?

Answer 8

decision made for an individual when the surrogate decision maker knows what the patient would want

Question 9

what is best interest standard ?

Answer 9

decision made about an individual patient’s health when the patient is unable to make it themselves

Question 10

substituted judgement standard vs best interest standard ?

Answer 10

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?”

Question 11

laws regarding euthanasia in the arab world ?

Answer 11

prohibited in the arab world

Question 12

what is passive euthanasia ?

Answer 12

intentionally letting a patient die by withholding artificial life support such as a ventilator or feeding tube

Question 13

what are the types of euthanasia ?

Answer 13

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

Question 14

assistance in suicide ?

Answer 14

knowingly and intentionally providing a person with the knowledge or means or both required to commit suicide

Question 15

what are the factors that must be fulfilled that are associated with permissible euthanasia ?

Answer 15

competent
incurable illness
voluntarily
no personal gain

Question 16

what is futile treatment ?

Answer 16

any treatment that, within a reasonable degree of medical certainty, is seen to be without benefit to the patient

treatment malhoosh lazma

Question 17

purpose of DNR ?

Answer 17

refusing artificial support
avoid futile treatment

Question 18

when is psychiatric consultation necessary in end of life treatment decisions ?

Answer 18

only if the patient’s capacity to understand is uncertain

Question 19

what triad is associated with thee definition of death ?

Answer 19

triad of bichat
irreversible loss of circulation
respiration
innervation (brain death )

Question 20

what is the difference between somatic and molecular death ?

Answer 20

somatic death eventually becomes molecular death

Question 21

what are the conditions that stop a death from being classified as a natural death ?

Answer 21

suspicion of accident
homicide
or suicide

Question 22

when should life support be switched off ?

Answer 22

must not be switched off as long as brain stem death is not legalized

Question 23

how to confirm clinical death ?

Answer 23

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

Question 24

clinical evaluation of brain death ?

Answer 24

absence or corneal reflex
absence of pupillary response
absence of gag reflex
absence of oculovestibular response

Question 25

what ddoess the doll’s eeyee phenomenon describe ?

Answer 25

absence of oculocephalic response

Question 26

brain death should be confirmed by :

Answer 26

1- three separate medical experts
2- not including anyone from the transplant team
3- perform examination twice 24 hours apart

Question 27

what are the conditions for living donors :

Answer 27

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

Question 28

what is persistent vegetative state ?

Answer 28

loss of higher cerebral powers
whilst still maintaining the function of the brainstem

Question 29

clinical presentation of persistent vegetative state ?

Answer 29

1- cyclic state of circadian sleep and wake
2- heads and eyes can follow a moving object or move towards a loud sound

Question 30

what is suspended animation / apparent death ?

Answer 30

the temporary cessation of most vital functions without death
seen in electrocution, massive doses of CNS depressants and yoga practitioners

Question 31

true or false brain death is a legal definition in Egypt

Answer 31

false

Question 32

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 ?

Answer 32

urine toxicology screen