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A Evidence Based Nursing (BN606) YR 2 > Lecture Seventeen: Ethics and the end of life > Flashcards

Lecture Seventeen: Ethics and the end of life Flashcards

1
Q

What is NURSING ETHICS?

A

“the examination of ethical and bioethical issues from the perspective of nursing theory and practice that, in turn, rest on the agreed core concepts of nursing, namely: person, culture, care, health, healing, environment and nursing itself…”

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2
Q

Why do nurses need a moral compass?

A

e.g. we have technology, but what action is right in THIS situation? We have ventilators etc- but does it mean it is right?

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3
Q

What are Personal values?

A

My beliefs and ideals e.g., ‘all life is sacred’ versus ‘suffering is intolerable’

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4
Q

What are Professional values?

A

Guide our interactions
e.g., nurse as patient advocate

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5
Q

What is moral agency?

A

ethics in action
i.e. how choices are made

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6
Q

What is Values clarification?

A

Understanding another’s values and wishes

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7
Q

Why is a code of ethics important?

A

provides a reference -
Set of values, principles or expectations that guide nurses in reflection and decision-making

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8
Q

What is a Principle based approach?

A

Applying ethical principles to practice:

Autonomy
Non-maleficence
Beneficence
Justice
Fidelity
Veracity

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9
Q

What is an example of autonomy?

A

Self determination: Risks and benefits of a procedure explained and understood when obtaining informed consent.

The right or condition of self-government.

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10
Q

What is an example of Non-maleficence?

A

Doing no harm when performing an intervention

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11
Q

What is an example of Beneficence?

A

Promoting the benefit of the patient.
Strong connotation of doing good to others including moral obligation

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12
Q

What is an example of Justice

A

Act fairly

Sharing time evenly across patients (equal access)

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13
Q

What is an example of Fidelity

A

Being faithful to a patient’s request, such as NOT to share their diagnosis with family

Principle that pertains to trustworthiness

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14
Q

What is an example of Veracity?

A

Telling only what you know to be the facts

Conformity with truth or fact

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15
Q

How do we respond to ethical dilemmas?

A

Assess the situation (gather data)

Identify the actual ethical issue

Identify options

Think it through to reach a decision

Implement the plan

Evaluate it

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16
Q

What is euthanasia ?

A

Deliberately bringing about the
death of a person to end what is
considered an intolerable existence

17
Q

What are the six kinds of euthanasia?

A

Voluntary passive
Voluntary active
Involuntary passive
Involuntary Active
Non Voluntary passive
Non Voluntary Active

18
Q

What is passive euthanasia?

A

Just kind of occurs. Maybe by not giving food and fluid

19
Q

What is active euthanasia?

A

Intervening and doing something to specifically end their life

20
Q

What is Voluntary euthanasia?

A

Competent person asks to die

21
Q

What is Involuntary euthanasia?

A

Person doesn’t have the opportunity to consent to die. Some of the killing that happened in WW2

22
Q

What is Non voluntary euthanasia?

A

Person does not consent or deny to consent. There isn’t the opportunity. If someone was a baby, or not legally competent.

23
Q

What are the 5 conditions to euthanasia?

A

1) Intentionality
2) Evidence of suffering
3) Motivated by beneficence
4) Painlessness
5) Non-fetal humanity

24
Q

What are points for and against euthanasia?

A

Against- It was morally wrong. Slippery slope argument. How to tell if someone was competence. Emotionally charged. There was a time frame (6 months terminal). Risk of abuse. Clinical uncertainty

For- Autonomy. What would stop someone from ending their own life by themselves? Reduce suffering

25
Q

What are some NZ law landmarks for euthanasia?

A

1995 ‘Death with dignity’ bill fails 61:29 votes (Michael Laws)

2012 ‘End of life choice’ bill presented (David Seymour)- 69/5. Passed. Proposed act

2020- ‘NZ Euthanasia Referendum’ at General Election to legislate the ‘End of life choice Act 2019’

26
Q

What was the END OF LIFE CHOICE Act 2019

A

Has passed into law.

To give individuals with a terminal illness (who meet certain criteria) a lawful option of requesting medication to end their life

Aims to ‘promote compassion and the preservation of dignity’

Nursing lacks a universal position on euthanasia – it is a matter of conscience – we may opt out

27
Q

How can we be sure that it is the person’s own decision, fully informed and free from coercion?

A

Ideal safeguards
- USA State senator Claire Ayer

Must ensure –
* Person has capacity
* Diagnosis is correct
* Cooling off period
* Clinical depression ruled out
* No discrimination against minority
groups
* Palliative care / hospice options
explained

28
Q

What happens if a health practitioner opts out of assisting euthanasia?

A

A health practitioner is NOT under obligation to assist a person who wishes to receive assisted dying (conscientious objection)

SCENZ - The ’Support and Consultation for End of Life in New Zealand’ holds the list of Doctors, Nurse Practitioners and Psychiatrists who are willing to be involved

A conscientious objector MUST inform the patient that they have a conscientious objection and tell them of their right to ask the SCENZ group for the contact details of a replacement medical practitioner

29
Q

What is the eligibility criteria for assisted dying?

A

Person must meet all of the criteria-
- Ages 18 or over
- A citizen or permanent NZ resident
- Suffering of a terminal illness that is likely to end their life within the next 6 months
- in an advanced state of irreversible in physical capability
- Experiencing unbearable suffering that cannot be relived in a manner that the person considered tolerable
- competent to make an informed decision about dying

30
Q

What are some key points to the assisted dying act?

A

A health practitioner cannot raise discussion around ‘assisted dying’

  • Must determine competence to make an informed decision (understand, use and weigh information) and can communicate that decision in some way
  • A person can change their mind at any time
  • Must encourage discussion with family, friends and counsellors
  • Must ensure decision is free from pressure by talking with:
    other health practitioners who are in regular contact
    members of the person’s family approved by the person
31
Q

What are some decisions a patient can make if they are going to be euthanised?

A

Date and time of medication administration

  • May delay this date for up to 6 months
  • Where they want to die e.g. hospital or home
  • Whānau or others present ?
  • Method of medication administration (ingestion or IV)
  • Self-administration or administration by a Doctor / NP

A Evidence Based Nursing (BN606) YR 2 (15 decks)

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