Ica End Of Life + Palliaive Care Flashcards
Know the definition of euthanasia
Euthanasia is the act of deliberately ending a person’s life to relieve suffering (NHS)
Active: deliberate act
- Passive: withholding or withdrawing treatment
Voluntary: patient request - Non-voluntary: without patient consent (or unable to give consent)
(physician) assisted suicide
Assisted suicide is the act of deliberately assisting another person to kill themselves (NHS).
- Physician assisted dying: prescribing life ending drugs for terminally ill, mentally competent adults to administer
themselves after meeting strict legal safeguards.
What doctors cannot do
BMA: Guidance for doctors - Assisted suicide
- Advise patients on what constitutes a fatal dose
- Advise on anti-emetics in relation to planned overdose
- Suggest option of suicide abroad
- Provide literature
- Disseminate information via (social) media that might encourage people to end their lives
- Put patients in touch with other groups or individuals
- Facilitate any other aspects of planning a suicide
Understand the principles of the doctrine of double effect
Permits health care professionals to administer potentially fatal medication, provided that their intentions are purely to control symptoms.
Same outcome(death) but intention matters.
Understand the current stance on euthanasia in the UK medical profession
Majority of doctors against physician assisted suicide
Opinions on how bma should respond:
- The role of the doctor
- Eligibility criteria
- Conscientious objection
Be able to list and discuss several key ethical principles involved in debates surrounding the topic of euthanasia
Autonomy
Respect a persons freedom to choose what’s right for them
Non-maleficience
Do no harm
Beneficence - all choices for a patient are made with the intent to do good
Justice
Treat and provide care fairly to all
Introduction to DNACPR and RESPECT forms
DNACPR
- Do not attempt cardiopulmonary resuscitation
What does DNACPR mean? - if a person stops breathing not doing CPR
Who can have a DNACPR? - frail patients who would be worse after CPR
Who’s decision is it? Patient’s request or doctor if not in patients best interest p. Must have a discussion with patient.
Re SPECT Forms
- Process to create personalized recommendations - includes DNA CPR - not legally binding and can be reviewed.
- Future emergencies
- Patient preference and clinical judgement - patient’s preferred place of death, how do they want to die, what are they afraid of.
Hospice care
Improve lives of patients living with an incurable illness
- From initial terminal diagnosis to end of life care
- Not necessarily continuous
- Holistic care
• Be able to define some key objectives of palliative care
• Be able to list several specific distinct services or interventions offered by many modern UK hospices to patients with life limiting illnesses (e.g. end stage heart failure or end stage COPD).
The active holistic care of patients with advanced, progressive illness with management of pain and other symptoms and provision of psychological, social and spiritual support being paramount.
Avoiding medicalisation and thus prolongation of
the dying process
• Avoid the situation of ‘medical captivity’ of being
a frightened patient. Enable their release from
‘captivity’ •
An agreed care plan is required avoiding
‘managed states’ (ReSPECT Form) / DNAR •
Ability to die one’s own death
• Adequate symptom control
Be able to list several specific challenges in achieving a ‘Good Death’
Truthfulness (honest/open) with patients • Enabling informed consent • Allowing time to prepare • Avoiding isolation • Overcoming a wall of silence • Maintaining hope by accompanying them on the journey
– (It is so important what you say to patients)
