Ethics of End of LIfe Care - Elliot Flashcards

1
Q

What are the four pillars of bioethics principles?

A

autonomy
beneficence
non-maleficence
justice

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2
Q

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

A

autonomy

beneficence

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3
Q

What’s the difference between competency and capacity?

A

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

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4
Q

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

A

capacity

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5
Q

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

A

they can refuse care - they can’t demand care

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6
Q

Which trumps the other: a guardian or a proxy?

A

guardian

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7
Q

What happens to tolerance of disability as we age?

A

it increases, but is not unlimited

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8
Q

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

A

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

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9
Q

What’s intent or double effect?

A

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

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10
Q

What are the “big Js” of justice?

A
societal justice issues
allocation of scarce resources
rationing
health care reform
clinical justice isssues
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11
Q

What are the “little js” of justice?

A
more focused on the individual hospital/patienta:
what resources are allocated
monitoring costs
cost vs benefit
ineffective care = futile care
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12
Q

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

A

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

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13
Q

Who should decide a person’s quality of life?

A

the patient

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

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14
Q

When do we forgo medical interventions?

A

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

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15
Q

When is CPR indicated?

A

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

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16
Q

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

A

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

17
Q

What states have death with dignity laws?

A
Washington
Oregon
Montana
Vermont
New Mexico
18
Q

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

A

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

19
Q

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

A
  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