Lecture 14: Palliative Care Flashcards
What are the 4 principles of medical ethics?
- Autonomy
- Nonmaleficence
- Beneficence
- Justice
What concepts fall under autonomy?
- Informed consent
- Freedom from control/interference
- Freedom from unwanted bodily intrustion
- Advance directives
What is our fiduciary duty?
Provide care that is in the best interest of the patient
Who determines decision making capacity and what is it?
- Ability of a patient to understand the benefits and risks
- Decided by a general clinican via cognitive test (clock draw most reliable)
- Psychiatry might be needed
- Decision is always determined based upon specific decision at hand
What is competence and who determines it?
- Ability to act reasonably after understanding the nature of the situation
- Determine by court of law
What are the 5 things to be assessed in decision making capacity?
- Patient must make decision
- Patient must be able to explain reasoning
- Decision cannot be due to delusion or hallucinations
- Demonstrate understanding (may need to reassess again)
- Consistent with patient’s values and preferences
What are some ways to making sure a patient is making an informed decision?
- Avoid medical jargon and info dumping
- Determine if patient knows prognosis
- Be cautious how info is presented
- Disclosing info is not the same thing as understanding
What is included in an advance directive?
- Living will
- Medical power of attorney
When is an advance directive indicated in terms of federral law?
Anyone entering a hospital or long-term care facility
What is in a living will?
- Life-saving measures
- Transfer
- Use of ABX
- Donation of organs
- Funeral stuff
If there is no designated MPOA or conservator, what is the order?
- Spouse
- Adult children
- Siblings
- Parents
- Healthcare team
What is palliative care?
Improving quality of life due to serious illness (not cure-focused)
It can be COMBINED with cure-focused treatments.
What is hospice care?
Palliative care variation when limited life expectancy is determined.
How does one become eligible for hospice care?
- Must have Medicare Part A
- 2 clinicians must determine patient has <= 6 months to live if disease runs expected course
- Patient must forgo curative treatments for terminal disease.
What is respite care?
Providing relief for family members that care for patient at home (aka admitting them temporarily to provide the family a respite)
