Resource Allocation and End of Life Flashcards
Why is defining death important
It enables us to make decisions about withdrawing treatment and removing organs for transplantation so is of vital importance
What is the code of practice for the diagnosis of brain stem death
• Coma not due to reversible causes • Several components of the brain stem permanently destroyed (this includes the respiratory centre) • Patient unable to breath spontaneously
Give reasons why different groups of people may be Decision makers as to whether to withdraw treatment
• Doctors: Medical expertise, objectivity o Clinical decisions that are ethically sound required skilled clinical assessment and knowledge • Family: Left with consequence, know the person best, may lose objectivity • Court: Objective view of best interest
Summarise the criteria of the mental capacity act
• All decisions must be made in the best interests of the person who lacks capacity • Any best interests decisions relating to life-sustaining treatment must not be motivated by a desire to bring about the person’s death • Before concluding that a person lacks capacity all possible steps must be made to help them reach a decision themselves • A person must not be assumed to lack capacity unless it is established that they lack capacity • Can they understand, retain, weigh up information and communicate their decision?
The questions to ask when determining someone’s best interest
Can we determine what Richard currently wants? • If he lacks capacity is he likely to regain it? • Is there evidence of his past wishes or views? • Is there an advance directive? • Has he appointed a Lasting Power of Attorney (LPA) • What is his prognosis with treatment, and what sort of recovery can we expect? • What are the views of his parents, children, friends, carers, rest of medical and nursing team
WHat should be done when there is uncertainty in regards to life sustaining treatment?
Continue life sustaining treatment (least restrictive option) • An application to the court of protection should be made
What happens in a persistent vegetative state
• Cerebral Cortex loses function and activity • Patients retain brain stem function • Able to breathe unassisted • Normal sleep-wake cycles • Periods of wakeful eye opening • Irreversible • No evidence of awareness • Swallowing reflex may be preserved • May survive for many years
Describe the leagal principles that may support withdrwal of treatment
- In the eyes of the law an act that is intended to result in death is unlawful
- Withdrawal of treatment constitutes an omission rather than an act
- The doctors are returning a patient to a position that he would have been in without treatment
What is The doctrine of double effect (DDE) and describe its application in law
• The doctrine of double effect (DDE): o Doctors frequently harm patients as a side effect of treatment (e.g. chemotherapy). o The DDE states that it is always wrong to perform a bad act although good may result, but it is sometimes permissible to perform a good act although harm may result. This distinction rests on the difference between what is intended and what is forseen. o If an action has a morally bad consequence, it is justified so long as: ▪ The bad consequence is not intended ▪ The good effect is not brought about by the bad effect ▪ The good effect must be sufficiently good to warrant the bad effect o Problems: ▪ What counts as a bad act? Is an abortion a bad act, if it is necessary to save a woman’s life? ▪ The result is important – we are responsible for our actions whatever the consequences are. Difference between something you intended to do and something you did not intend, but that you could have forseen would happen. ▪ How do we decide what is intended vs what is forseen – if something is virtually certain to occur, does it count as intended or as forseen? ▪ We can still be morally responsible for consequences we forsee, but do not intend. o Application in law: ▪ If a doctor believes a treatment is beneficial but carries a risk of death, this is permissible (as long as death is not intended). ▪ If a doctor administers treatment with the primary aim of shortening life, they have committed murder. It makes no difference if the patient was terminally ill, as you are still shortening their life from what it would have been otherwise.
Describe what the Suicide Act 1969 states
‘a person who aids, abets, counsels, or procures the suicide of another, or an attempt by another to commit suicide shall be liable on conviction or indictment to imprisonment for a term not exceeding 14 years.’
What is the DPP guidance for suicide
• Factors in favour of prosecution: • the victim was under 18 years of age; • the victim did not have the capacity to reach an informed decision to commit suicide; • the victim had not reached a voluntary, clear, settled and informed decision to commit suicide; • the suspect was not wholly motivated by compassion • the suspect pressured the victim • the suspect was paid by the victim or those close to the victim • the suspect was acting in his or her capacity as a medical doctor, nurse, other healthcare professional, a professional carer [whether for payment or not], or as a person in authority…and the victim was in his or her care
An essential element of making good ethical decisions is good clinical assessment • Where patients lack capacity, consider if they may regain it, and deferring a decision • If there is uncertainty then treatment should be aimed at prolonging life as this is the least restrictive option • Concepts such as the sanctity of life, the acts/ omissions distinction and the DDE have been used to shape the law • These concepts can be interpreted and critiqued • Intentional killing is murder in the eyes of the law • Aiding and abetting suicide is a criminal offence • In the eyes of the law patients’ requests or advance requests for treatment do not place an obligation on doctors to provide it, where it is not medically indicated or in the patient’s best interests
An essential element of making good ethical decisions is good clinical assessment • Where patients lack capacity, consider if they may regain it, and deferring a decision • If there is uncertainty then treatment should be aimed at prolonging life as this is the least restrictive option • Concepts such as the sanctity of life, the acts/ omissions distinction and the DDE have been used to shape the law • These concepts can be interpreted and critiqued • Intentional killing is murder in the eyes of the law • Aiding and abetting suicide is a criminal offence • In the eyes of the law patients’ requests or advance requests for treatment do not place an obligation on doctors to provide it, where it is not medically indicated or in the patient’s best interests
What is the current medical definition of death
permanent loss of brainstem functions.
Discuss ethic problems with act and omissions
Not always a clear distinction – is turning off a ventilator an act (of stopping treatment) or an omission (omitting to treat)? o In cases where an omission will have the same consequences, is an omission as bad as an act? I.e. is failing to perform an act with foreseeable bad consequences less bad than performing an act with similar bad consequences? o Where there is a duty to act, an omission may be almost as bad e.g. omitting to give insulin to a diabetic patient. o If we know that withdrawing treatment will result in the patient’s death, then it may be argued that his death is intended by withdrawing treatment. o Is there a moral distinction between withdrawing treatment or actively ending the patient’s life, if both courses of action will result in the patient’s death?
Explain how Acts and Omissions are legally viewed
o In the eyes of the law, an act that is intended to result in death is unlawful, even if the motive for causing death is good or compassionate. o To find a person guilty of murder, a jury must find that: ▪ The person caused the death ▪ There was an intention to cause death or grievous bodily harm (this intention can be direct or indirect – indirect action is where the act is virtually certain to cause death, and the person performing the act knows this). ▪ No other defence can be raised o Withdrawal of treatment constitutes an omission rather than an act, as the doctors are seen as returning a patient to the position that he would have been in without treatment. o Withdrawing treatment that is no longer in a person’s best interests is lawful. o However, we need to consider if there is a duty or a moral obligation to treat:
▪ The omission is only permissible on the basis of there being “no duty to treat”. ▪ The duty to treat can only be established by making a value judgement as to whether the patient’s life is worth living. ▪ When treatment is futile, there is no duty to treat. o The patient is to be regarded as having died of their condition, rather than due to the action/inaction of the doctor.
