Ethics of End of LIfe Care - Elliot

Question 1

What are the four pillars of bioethics principles?

Answer 1

autonomy
beneficence
non-maleficence
justice

Question 2

Which of the bioethcis principles come up most in end of life care decision making?

Answer 2

autonomy

beneficence

Question 3

What’s the difference between competency and capacity?

Answer 3

capacity - the ability to understand RIGHT NOW
competence - a legal term pertaining to a dichotomous setting where you’re either competement or not competent - decided by a judge

Question 4

Which will be more important for us as physicians - capacity or competence?

Answer 4

capacity

Question 5

Do patients have the right to refuse care, demand care or both?

Answer 5

they can refuse care - they can’t demand care

Question 6

Which trumps the other: a guardian or a proxy?

Answer 6

guardian

Question 7

What happens to tolerance of disability as we age?

Answer 7

it increases, but is not unlimited

Question 8

What are the main considerations for non-maleficence in end o flife care?

Answer 8

risk vs benefit in the context of medicine vs. quality of life considerations

Question 9

What’s intent or double effect?

Answer 9

It is moral to make a decision that can cause harm if you do it in the intent of doing good

an example of the respiratoyr depression that comes with opioid use

Question 10

What are the “big Js” of justice?

Answer 10

societal justice issues
allocation of scarce resources
rationing
health care reform
clinical justice isssues

Question 11

What are the “little js” of justice?

Answer 11

more focused on the individual hospital/patienta:
what resources are allocated
monitoring costs
cost vs benefit
ineffective care = futile care

Question 12

How do the paternalistic and informative relationship models differ in decision making and what pillars of bioethics do each uphold?

Answer 12

paternalistic = making the decision without the consent of the patient - it’s beneficence vs non-maleficence to the extreme because “we know best”
INformative is only giving the patient info and no advice - this is autonomy to the extreme

Question 13

Who should decide a person’s quality of life?

Answer 13

the patient

studies have shown that doctors and family always rate the patient’s QOL higher than the patient does. So LISTEN

Question 14

When do we forgo medical interventions?

Answer 14

when the interention is likely to offer little benefit otmeeting patient goals or sustaining desired QOL

Question 15

When is CPR indicated?

Answer 15

in an unexpected, observed cardiac arrests where there isn’t an underlying comorbid condition causing the arrest

Question 16

What are the two different criteria for determining death before organ donation?

Answer 16

brain death - declare death, recheck 24 hours later, if still dead, then start donation discussion
cardiac - when there’s still some brain activity, but no chance the person is going to come back

Question 17

What states have death with dignity laws?

Answer 17

Washington
Oregon
Montana
Vermont
New Mexico

Question 18

What’s the difference between physician-assisted suicide and euthanasia?

Answer 18

In PAS the patient has to administer the lethal dose, in euthanasia, the doctor does

Question 19

What are the 7 steps in the case method for ethics analysis?

Answer 19

1. state the ethical question
2. review the medical considerations
3. identify the involved parties
4. Identify the values of everyone involved
5. address context and constraint
6. propose options and choose
7. make the recommendation