Moral Concern Flashcards
When is moral concern important?
When there is the potential to help or harm
What 6 factors make up the criteria for moral concern?
Only require 1: Sentience Human Autonomy Personhood Potentiality Patient
Describe the sentience criteria.
The capacity to feel, perceive and experience pain or pleasure. The ability to feel pain means the neurological system is intact even if it cannot be communicated. It is assumed pain is not desired and so it is a HCP role to reduce pain even in fetus over 20wks and Pts on life support.
Describe the human criteria.
The sanctity of human life. It is based on personal beliefs, religious and professional views of life. Some may feel all life is sacred and so some medical actions may be considered killing e.g. abortion, withdrawal of life saving treatment, DNR. May also view life as a biological process.
Describe the autonomy criteria.
Wishes of patients should be respected as they have the right to decide for themselves. It is based on the capacity and rational of the request. Vulnerable Pts such as psychiatric, young and elderly may require someone else to make the decision. A request may be rationale but not for the right reasons. Have to consider if they would make this request if they weren’t suffering from a psychological illness.
Describe the personhood criteria.
The quality of being an individual person and having the ability to have conscious mental states e.g. rational thoughts, plans for future. It provides a right to life. If these mental states are no longer possible, they are considered to be no longer human e.g. fetus and neonates.
Describe the potentiality criteria, if considered no longer a person.
Although a Pt may lack the other areas for moral concern in their current state, have to consider if they are likely to develop it in the future. It affects whether a treatment should be continued, increased or removed. It is used to protect fetuses and justifies life support until improvement or until pointless.
Describe the patient criteria, if no longer considered a person.
All Drs have a duty to the Pts, regardless of their status. It is based on the duties and obligations to care, even when all other criteria or missing. However this has a legal limit. Treatment can only be given if it has the POTENTIAL TO BENEFIT or else it is considered battery.
What is the definition of death?
Irreversible cardiopulmonary arrest
What is biological death?
Brain stem death - herniation or loss of perfusion to brain stem leads to loss of vital biological functions e.g. respiration and homoeostasis. The heart continues to beat so these Pts are suitable organ donors.
When can brain stem death be confirmed?
Neuronal tests are carried out every half an hour to identify the level of perfusion remaining. If the test is failed twice, they’re declared dead, but time of death is when the first test was carried out.
What are the signs of a biological death?
Fixed dilated pupils
No blinking
No gag reflex
No respiratory stimulation when CO2 rises
What is a Biographical death?
Persistent vegetative state - Death of the upper brain due to loss of perfusion to cortex but an intact brainstem. It causes irreversible loss of conciousness and all higher functions. Vital functions still remain and so it is not a legal death as life can be sustained on support.
On what basis with PVS Pts continue to be treated and under what conditions will they die?
Treated based on the sanctity of life and still have the same life expectancy as before. Death will only occur if nutrition is withdrawn or an infection is untreated.
What is the criteria for a PVS Pt?
Must exclude all causes of a persistent coma e.g. hypothermia, toxins. Must lack clinical signs for 6-12 months:
No awareness
No response to stimuli - auditory, noxious
No evidence of language comprehension
Sleep/wake cycles maintained but no eye activity
No activity on fMRI in response to Q
