Ethics, Law and Palliative Care

Question 1

What is a Consequentialist?

Answer 1

the RIGHT response is related to the outcome

Beneficence (do good) 
Non Maleficence (do no harm)

Question 2

What is a Deontological view?

Answer 2

The RIGHT approach is fulfilling duties and responsibilities

Respect for Autonomy (self determination) - The patient as the principal decision maker
Distributive Justice - “Fairness” and balancing the needs of individuals with those of society

Question 3

What is Virtue Ethics?

Answer 3

the RIGHT response is the one made with moral character

Question 4

What is principlism?

Answer 4

often used in healthcare settings

Question 5

What is the Mental Capacity Act 2005?

Answer 5

Provides the legal framework for the care and treatment of those who may NOT be able to make decisions for themselves.

Underlying philosophy is to ensure that any decision made, is made in “best interests”.

ntroduces several new roles
Lasting Powers of Attorney
The new Court of Protection, and court-appointed deputies
Independent Mental Capacity Advocates

Question 6

What is classed as an impairment or disturbance of the mind or brain?

Answer 6

Conditions associated with some mental illness 
Dementia 
Significant learning disabilities 
Long-term effects of brain damage 
Physical or medical conditions that cause confusion, drowsiness or loss of consciousness 
Delirium 
Concussion following a head injury 
Symptoms of alcohol or drug use

Question 7

What is advance Decision to Refuse Treatment - ADRT?

Answer 7

A decision relating to a specific treatment in specific circumstances

• Relates to refusal (NOT request) for treatment
• Can be written or verbal
• Must be written, signed and witnessed if it includes a refusal of life sustaining treatment
• Will come into effect only when the individual has lost capacity to give or refuse consent
• Is legally binding
• Should be shared with family and MDT
• Must be valid and applicable

Question 8

What is the ethical analysis of CPR

Answer 8

Beneficence - restart cardiac and respiratory function
Maleficence - brutal, rib #, anoxic brain injury, ventilation, poor survival and discharge rates even after successful CPR
Justice - not in interests of distributive justice to offer if “futile” - shouldn’t offer CPR to patients who have advanced disease because when they die of their disease, CPR won’t be helpful - CPR not a valid treatment and shouldn’t be offered in this case
Autonomy - consent for CRP, DNACPR needs to be informed. Patient is decision maker, not family. Patients is not offered decision regarding treatment where it is deemed futile, but entitled to second opinion on the futility issue.