Lesson 6 Flashcards
Chapter 16 - Ethical and legal Issues at the End of Life
How does total brain death differ from higher cortical brain death in terms of brain function?
Total brain death is the irreversible loss of function in the entire brain, including the brainstem.
Higher cortical brain death is the loss of higher cognitive functions (e.g., consciousness, social interaction) while some lower brain functions (e.g., brainstem activity) may remain.
A patient has no circulatory or respiratory function. What type of death has occurred?
Cardiac death, as it is defined by the irreversible cessation of circulatory and respiratory functions
Why is higher cortical brain death considered ethically controversial?
It raises debates about personhood, as the body can still function at a basic level despite the loss of consciousness and awareness.
What are the four essential criteria for determining total brain death according to the Harvard Medical School Committee?
Lack of response to external stimuli
No spontaneous muscle movement or breathing
No observable reflexes (brain & spinal)
Flat EEG indicating no brain activity
Why must a second set of tests be performed after 24 hours?
To confirm brain death and rule out temporary conditions like drug effects or recovery potential.
What conditions must be excluded before determining total brain death?
Hypothermia and drug overdoses, as they can mimic brain death.
How does the Law Reform Commission define death in Canada?
Death occurs when there is an irreversible cessation of all brain functions.
How do international laws on brain death vary?
Some countries have clear guidelines, while others have none. About 2/3 of the world’s countries lack official regulations.
What does the term “postal code death” refer to, and why is it significant?
It refers to the variation in death determination based on location, meaning different hospitals or regions may follow different standards.
Why might families feel pressured when making end-of-life decisions for brain-damaged patients?
They may be given the impression that there is no hope, face growing pressure due to limited medical resources, or fear that even if revived, the patient will not return to their previous state.
What is one reason awareness campaigns have had little impact on organ donation rates in Canada?
Public hesitation, lack of education, and family objections still limit donor registrations.
What happened to organ donation rates in Canada after 2011, and how did COVID-19 affect them?
They increased but later stagnated and declined due to pandemic-related healthcare disruptions.
According to the Dead-Donor Rule, what condition must be met before organ removal?
The removal of organs must not cause the donor’s death.
According to the Human Tissue Gift Act (1996), what legal protections exist for organ donors in Canada?
A donor card is legally binding and cannot be overridden by family or a substitute decision-maker (SDM). Donors must be declared totally brain dead before organ removal, and no financial compensation is allowed for donation.
How could adopting a higher cortical brain death standard impact organ donation rates?
More organs would become available since patients with irreversible loss of higher brain function could be considered for donation.
What is the purpose of advance directives, and why are they important for end-of-life care planning?
Advance directives allow individuals to make decisions about their medical care in case they become incapacitated, ensuring their preferences are honored and reducing the burden on family members.
What are some limitations of living wills, and why might their significance and force be subject to interpretation or dispute?
Living wills may not anticipate every complex situation that could arise at the time of death, leading to potential disputes among family members and healthcare providers over their implementation.
What are the two significant advantages of using a durable power of attorney for health care decisions over other written directives like living wills?
A durable power of attorney allows a substitute decision maker to make decisions in all circumstances, and the proxy has the flexibility to approve or refuse specific interventions, adapting to changing conditions.
What five things does the Five Wishes document help people decide about their health care?
It helps decide who makes health care decisions, what treatments to accept or refuse, how to stay comfortable, how to be treated, and what to share with loved ones.
What is the definition of death according to the Uniform Determination of Death Act (UDDA)?
The UDDA defines death as the irreversible cessation of either circulatory and respiratory functions or all functions of the entire brain, including the brain stem.
What is the NASH system, and how is it used in classifying deaths?
The NASH system is used to classify the manner of death into four categories: natural, accidental, suicide, or homicide. Some deaths may be categorized as “undetermined” or “pending investigation.”
What are the differences between coroners and medical examiners in terms of their qualifications and responsibilities?
Coroners are typically elected officials and may not require special qualifications, though some may be funeral directors. Medical examiners, on the other hand, are appointed and must be qualified medical doctors, often forensic pathologists.
Why is it ethically challenging to ask the loved ones of critically-ill family members about organ donation?
It is ethically challenging because the family is often in a state of emotional distress, and the decision to discuss organ donation may feel intrusive or insensitive during such a difficult time.
What is the concept of “presumed consent” as it applies to Nova Scotia’s legislation on organ donation?
Nova Scotia recently passed legislation that presumes consent for organ donation unless individuals explicitly opt-out. This means that unless a person has formally stated their wish not to donate their organs, they are presumed to have given consent for organ donation upon their death.
