Moral Concern Flashcards
Criteria for who is worthy of moral concern
Patient Autonomy Personhood Potentially Human Sentience
Sentience
Ability to feel pleasurable or painful stimuli
Feeling pain it is the assumption don’t want to feel pain so are treated for that
Clinical application
Is that during abortion after 20 weeks the fetus is given pain relief so not to feel pain
Human
Sanctity of life that human life is more special than other life forms
Against abortion, euthanasia, DNR, withdrawing life saving treatment
Personhood
Patient can no longer have rational thoughts or feelings, or desires for the future, no continuous mental states so they are biologically here but not biographically - the patient may no longer be a person if they do not meet these criteria
Autonomy
Patient ability to make decisions
If they can’t so a child, elderly, vulnerable, psychiatric patients, confused someone needs to make them for them, difficult grounds to establish
Respect the wishes of an autonomous person
Wrong to frustrate autonomy because patients can’t make decisions or be responsible
Potentiality
When a person may not meet some of the criteria for moral concern at this point in time but with treatment they will return - likely to get better, don’t turn of life support because they could get better but this is to a certain extent as futility can be reached
Patient
As a doctor you have a right to treat your patient - duty of care to patients irrespective of their philosophical state
To a certain extent legally when other grounds a missing and futility is reached
When is a patient dead?
Moral cancer changes when a patient dies - the duties, obligations and rights change
Conventionally death is when Cardio-pulmonary arrest is irreversible
2 clinical states challenge this
-PVS
-brain stem death
Biological death vs biographical death
Brian stem death
Death if the vital biological functions of the brain - so can no longer control respiration, temperature, fluid balance. Heart continues to beat if oxygen is delivered - biological death legally recognised diagnosis so they can’t believe without a ventilator
These patient are good contenders for organ donation, as the organs can be harvested as they can be kept alive and working with a ventilator
Permanent vegetative state
Death of the upper brain - brain stem is intact
Irreversible loss of consciousness and all higher functions - voital biological functions - respiration, temperature control, fluid balance still occur - birth there is no personhood
This is described as biographical death
No interests
Tony Bland
Diagnosis of PVS
Royal college of physician guidelines
Royal hospital of neuro-disabilities
-exclude all other causes of persistent coma
Observe the following lack of clinical signs for 6-12months
-no awareness of self and the environment
- no response to visual, auditory, tactile or noxious stimuli
- no evidence of language comprehension
- sleep wake cycles maintained
How do we know PVS is permanent unconsciousness
We don’t really
Tests that they do can be unturned with the PET brain activity scan in response to questions.
Answer questions by using bits of the brain thinking about different things highlights different areas of the brain so can answer yeah and no questions depending on what they are thinking
Whine,se may present as PVS but be aware
Minimal awareness state
Locked in syndrome
Guillian barre syndrome
How should we treat patients with pvs
Does the diagnosis matter
Do we carry on treating them
Help them to try to get better
