Week 8 - End of Life Ethics

Question 1

What is palliative care?

Answer 1

-Medical care that concentrates on reducing the severity of symptoms (prevention and relief)
- instead of providing a cure or halt the progression of disease
- improves quality of life of patient and family (life-threatening disease)

Question 2

What’s the difference between palliative care and end of life care?

Answer 2

Palliative care= lasts longer and is broader

Question 3

What is euthanasia?

Answer 3

A deliberate act undertaken by one person with the intention of ending the life of another to relieve suffering.

Question 4

What are the two types of euthanasia?

Answer 4

1. Active
2. Passive

Question 5

What is active euthanasia (AE)?

Answer 5

Physician takes an active, deliberate step to end a patient’s life
e.g. injecting potassium chloride

Question 6

What is passive euthanasia (PE)?

Answer 6

Intentionally letting patient die by withholding artificial life support (ventilator, feeding tube)
Some ethicists distinguish between withholding life support and withdrawing life support.
e.g. Not giving medication or surgery that would save a patient’s life.

Question 7

What do the different Acts say about suicide?

Answer 7

1. Mental Capacity Act (2005) = patients with capacity can refuse life-saving treatment
2. Human Rights Act (1998) = protects right to freedom from inhuman and degrading treatment
3. The Suicide Act (1961) = suicide is unlawful

Question 8

What is suicide?

Answer 8

The act of intentionally ending one’s own life.

Question 9

What is assisted suicide (AS)?

Answer 9

-Suicide undertaken with the aid of another person
-Normally refers to physician-assisted suicide (PAS) = suicide assisted by physician or another healthcare provider.

Question 10

What is Voluntary Euthanasia?

Answer 10

Behaviour which caused the patient’s death at the patients request.

Question 11

What is non-voluntary Euthanasia?

Answer 11

-Occurs when person is unconscious or otherwise unable to make choice between living or dying
-Appropriate person makes decision on their behalf
- Behaviour that causes euthanasia without consent or objection of the patient

Question 12

What arguments are for euthanasia?

Answer 12

1. Consistency:
   - Suicide is accepted
   -from passive to active euthanasia
   -from painkillers to lethal injections
2. Appeal to principles:
   -Autonomy
   -Beneficence

Question 13

What arguments is there against Euthanasia?

Answer 13

1. Sanctity of life
2. Palliative Care
3. Slippery slope argument
4. Killing is wrong
5. Non-maleficence
6. Physician Integrity
7. Protection of the vulnerable

Question 14

What is terminal sedation?

Answer 14

-Palliative sedation/ terminal sedation/ continuous deep sedation/ sedation for intractable distress of dying patient
-It is the relieving of distress of terminally ill person in the last hours/ days of their life
-Usually by continuous intravenous/ subcutaneous infusion of sedative drug/ specialised catheter designed to provide comfortable and discreet administration of ongoing medications via rectal route

Question 15

What is the doctrine of double effect?

Answer 15

1. Nature of act is not bad
2. Atleast one of the act’s consequences is good
3. Atleast one of the act’s consequences is bad
4. There is a sufficiently serious reason for letting the bad consequences occur
5. The bad consequence is not means to the good consequence
6. The agent foresees the bad consequence but intends the good consequence

Question 16

What does DPP stand for?

Answer 16

The director of public prosecution

Question 17

What factors weigh in favour of prosecution?

Answer 17

1. Under 18
2. Questions about capacity
3. No clear, settled and informed wish to die
4. Equivocal about dying
5. Process not initiated by person who dies
6. No terminal illness, severe and incurable physical disability or severe degenerative disease
7. Not motivated by compassion
8. Evidence of persuasion, coercion, undue influence/ pressure

Question 18

Factors that weigh against prosecution?

Answer 18

1. Clear, settled, informed wish to die
2. Unequivocal and consistent about dying
3. Initiated by person who died
4. Person had a terminal illness, severe degenerative disease with no possibility of recovery
5. Evidence that patient is motivated only by compassion
6. Person offering assistance is spouse, partner, close relative or friend within context of long-standing and supportive relationship
7. Assistance provided was minor

Question 19

What are the key controversies of euthanasia?

Answer 19

1. Killing vs letting die
2. Ordinary vs extraordinary treatment
3. Death intended vs anticipated