Week 7: Legal and Ethical Issues at the Beginning of Life Flashcards
What is futility?
Futile treatment isa type of care which does not fulfill the intended goalsand includes: A treatment which does not provide a reasonable chance of survival.
What is quantitative or medical futility?
when the proposed intervention is highly unlikely to achieve the desired effect
What is qualitative futility?
when the proposed intervention, if successful, will probably produce such a poor outcome that it is deemed best not to attempt it
What are our obligations when a patient wants something that is futile?
- There is no obligation to provide treatments known to be ineffective – e.g., antibiotics for a virus
- There is a continued obligation to provide what is indicated – e.g., empathy, communication, comfort care
What is gene therapy?
Gene therapy is making it possible to cure or prevent certain congenital conditions
- May have unexpected/unintended effects
- May affect all future generations/evolution (germline editing)
- Future generations cannot consent
Right to an open future
The “right to an open future” doctrine suggests that:
Parents should not make choices that restrict future rights
This means erring on the side of providing lifesaving measures so that a child can reach a developmental stage where they can make their own choices
E.g. For a child born with a genetic condition such as cystic fibrosis, parents generally consent to medical intervention in infancy so that the child has the opportunity to grow to an age where they can decide if they want continued or more invasive interventions.
Right to try in Canada
Currently, Canadians don’t have the right to use drugs that Health Canada has not approved. This means that even the seriously and terminally ill whose lives could be saved by using new, experimental drugs may have to wait for them to be approved for public use.
Withholding treatment
A competent person, or the substitute decision maker acting on their behalf, has the right to request that any ongoing medical intervention be stopped or withdrawn.
Again, the request needs to be well-informed and made by the patient or their substitute decision maker (e.g., the parent).
Again, it is the underlying condition that causes the death, not the withdrawal.
Withholding treatment
A competent person, or their substitute decision maker acting on their behalf, has the right to refuse any medical intervention, even if it means they will die.
The patient’s underlying causes their death, not the act of withholding the
intervention.
They need to be making a fully informed decision.
Decision-making around what kind of interventions to provide an extremely premature infant include
Informed consent
Autonomy
Best interests
Quality of life
Purpose of Informed Consent
Actions may be well-meaning but are not necessarily risk free
Nurses must respect & promote patient autonomy or choice, do good, and prevent/avoid harm
Promotes dignity and recognizes inherent worth
Ensures treatment plans are aligned with their values
Provides an opportunity to prepare for risks and minimize harms
Purpose of Informed Consent
Actions may be well-meaning but are not necessarily risk free
Nurses must respect & promote patient autonomy or choice, do good, and
prevent/avoid harm
Promotes dignity and recognizes inherent worth
Ensures treatment plans are aligned with their values
Provides an opportunity to prepare for risks and minimize harms
Elements of consent for health care intervention
Capacity – the person must have the legal and mental capacity to make a decision about the treatment.
Voluntary – the consent must be given freely and without coercion or a lack of important relevant information.
Understanding – all relevant information about risks and benefits required to make a decision that is consistent with their values, in a way they can easily understand.
Elements of consent for health care intervention
Capacity – the person must have the legal and mental capacity to make a decision about the treatment.
Voluntary – the consent must be given freely and without coercion or a lack of important relevant information.
Understanding – all relevant information about risks and benefits required to make a decision that is consistent with their values, in a way they can easily understand.
