Ethics of End of LIfe Care - Elliot Flashcards
What are the four pillars of bioethics principles?
autonomy
beneficence
non-maleficence
justice
Which of the bioethcis principles come up most in end of life care decision making?
autonomy
beneficence
What’s the difference between competency and capacity?
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
Which will be more important for us as physicians - capacity or competence?
capacity
Do patients have the right to refuse care, demand care or both?
they can refuse care - they can’t demand care
Which trumps the other: a guardian or a proxy?
guardian
What happens to tolerance of disability as we age?
it increases, but is not unlimited
What are the main considerations for non-maleficence in end o flife care?
risk vs benefit in the context of medicine vs. quality of life considerations
What’s intent or double effect?
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
What are the “big Js” of justice?
societal justice issues allocation of scarce resources rationing health care reform clinical justice isssues
What are the “little js” of justice?
more focused on the individual hospital/patienta: what resources are allocated monitoring costs cost vs benefit ineffective care = futile care
How do the paternalistic and informative relationship models differ in decision making and what pillars of bioethics do each uphold?
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
Who should decide a person’s quality of life?
the patient
studies have shown that doctors and family always rate the patient’s QOL higher than the patient does. So LISTEN
When do we forgo medical interventions?
when the interention is likely to offer little benefit otmeeting patient goals or sustaining desired QOL
When is CPR indicated?
in an unexpected, observed cardiac arrests where there isn’t an underlying comorbid condition causing the arrest