Lecture 10: Dying and Aging

Question 1

Death

Answer 1

Irreversible loss of circulation and respiration or irreversible loss of brain function

Question 2

When is death considered premature?

Answer 2

if it occurs before the age of 70 or 75

Question 3

psychological definition of death

Answer 3

the possibility of the impossibility of any existence at all

Question 4

Palliative Care

Answer 4

care intended to reduce pain and discomfort and improve quality of life in patients with chronic/terminal illness
- standard form of care in nursing homes regardless of prognosis

Question 5

Hospice palliative care

Answer 5

relief of suffering from terminal illness
- designed to provide warm, personal comfort at the end of life; begins after the treatment of the disease is stopped
- pain is managed and invasive treatments are discontinued
-psychological comfort and increasing social support are key goals
- may extend beyond a person’s death to assist in bereavement

Question 6

hospice care

Answer 6

may occur in palliative care units of hospital s, freestanding hospices, or in homes (home-based hospice services)
- only 16-30% of Canadians who die currently have access to or receive hospice palliative and end-of-life care services

Question 7

Palliative Care and Qof L

Answer 7

Palliative care is associated with:
- lower pain
-improved QofL
- lower anxiety and depression
- reduction in disease symptomology
-prolonged survival
patients who receive palliative/hospice care have significantly lower health care costs than those who do not

Question 8

Futile Medical Caare

Answer 8

The continued provision of care or treatment to a patient when there is no reasonable hope of a cure or benefit

Question 9

Ethical Dilemma of Futile Care

Answer 9

Is the treatment really futile? There is almost always a degree of uncertainly. Who has the right to determine futility?

Question 10

Goals of end of life care for medical staff working with dying patients

Answer 10

• informed consent (offer knowledge, encourage involvement)
• safe conduct (act as helpful guides for the patient)
• significant survival (help patients make the most of time)
• anticipatory grief (engaging in grief before they are gone)
• timely and ‘appropriate death’ (patient should be allowed to die when and how they want, as much as possible)

overall just help the patient achieve death with dignity

Question 11

End of life care on care providers

Answer 11

• emotionally draining
• unpleasant custodial work
• not curative care
• less interesting / stimulating

although working with dying patients may increase burnout, studies have shown that palliative care nurses are less burned out than other nurses

Question 12

Medically Assisted Dying

Answer 12

a physician knowingly and intentionally provides a person with the knowledge or means (or both) required to end their life, including counselling about lethal doses of drugs prescribing such lethal doses of drugs, or supplying the drugs

Question 13

euthanasia

Answer 13

deliberately ending a person’s life to relieve their suffering (NOT MAiD)

Question 14

Assisted dying in canada

Answer 14

Bill C-14 - passed in 2016 permissing MAiD for mentally competend adults who have serious and incurable illness or disability; are in an advanced state of irreversitble decline; and face a reasonably forseeable death

Bill C-7 was passed in 2021, expanding access to MAiD by removing the requirement that death be “reasonably foreseeable”

Question 15

Reasons for choosing MAiD

Answer 15

functional decline or inability to participate in meaningful activities is a main factor motivating the MAiD request

Also loss of autonomy and loss of dignity

Question 16

Concerns and Criticisms of MAiD

Answer 16

• Incompatability with care providers ethics
• eroors in diagnoses or prognoses
• coersion by family members or physicians
• suicide contagions
• impact on the bereaved
• disproportionate impacts on vulnerable groups
• expanding MAiD to mental illness

Question 17

Disproportionate impacts of MAiD

Answer 17

after analyzing the rates of assisted dying in Oregon and the Netherlands they found no evidence of heightened risk for vulnerable populations

ONLY GROUP W A HEIGHTENED RISK IS THOSE W AIDS

Question 18

SES and MAiD

Answer 18

it is unlikely to be driven by social or economic vulnerability

ppl w lower SES were LESS likely to receive MAiD

Question 19

MAiD due to suffering from a mental illness - 4 themes emerging as patient motivations

Answer 19

• autonomy and self determination
• ending the suffering
• recognition
• a dignified end-of-life

Question 20

Addiction and MAiD

Answer 20

caution should be exercised in accepting addiction as a reason for performing MAiD as the willingness to facilitate their deaths may add to their vulnerability

Question 21

Stages of dying

Answer 21

1. denial
2. anger
3. bargaining
4. depression
5. acceptance