Each person ______________ _______________ to death, and what comes after death.
attaches meaning
What is the "ideal death" frequently associated with?
Lack of pain
Lack of pre-death disability
presence of loving family/others
How do some find further understanding and meaning of death?
Continued contemplation
Imaginative, dramatic rehearsal of death (how they want it to happen)
What are the Nurse's Responsibilities in Suffering? (3)
Compassion
Alleviation of suffering
Understanding of the patient's desires (e.g. the patient does not want to be "out of it")
What is the difficult balancing act with pain?
For many patient's near the end of life it can be difficult to alleviate the patient's pain without sedating them to unconciousness
Why do ethical dillemas revovling around a patient's family come about?
Death is not talked about with the family, different members want different things or believe the patient would want different things
Define Euthenasia
The act of intentionally ending a life to alleviate suffering.
In the Neatherlands what is the criteria for euthanasia?
Not need for a terminal illness, but illness must be associated with pain
What is the goal of Euthanasia?
To bring about death
Define Cardiopulmonary death
Cessation of breathing and heartbeat
Define Whole brain death
Irreversible cessation of all brain functions
Define Higher brain death
Irreversible cessation of the capacity for conciousness
What is an advanced directive?
A written expression of a person's desire for treatment
When did advanced directives really come to the forefront? From what?
1990, PSDA (Patient Self-Determination Act)
What was the first type of advanced directive?
A living will
In illinois, what is the criteria to use a Living Will?
Person must not have decisionnal capability AND have a terminal illness.
What is a Durable Power of Attorney?
A written appointment of someone to make decisions for you (your surrogate)
What is the criteria for A Durable Power of Attorney?
Occurs at any time in the life cycle (person need not be terminal) BUT must have loss of decisional capacity.
What is the standard surrogates use?
Substituted Judgement" "I talked to Mr. Green and he said this is what he wanted to happen if X happens."
They are making the decision the patient would make, if they had capacity.
How are Advanced Directives abused (overused)?
A Dr. may prefer to talk to the younger child with power of attorney than to their older patient.
Also if there is a language barrier.
Are advanced directives a federal or state document?
State, and they vary between states.
When is a Health Care Surrogate Act used?
When there is an absence of an AD.
What is the 2 criteria to enact the Surrogate Act?
1. Patient has no decisional capacity and no AD.
2. Must have qualifying condition to withdraw/withhold treatment (terminal, permanent unconciousness, irreversible)
What are is the top 3 in the hierarchy for The surrogate Act?
1. The patient's guardian of the person
2. The person's spouse
3. Any adult son or daughter of the patient
What was the first well-known case of Withdrawing/Withholding treatment?
Karen Quinlan
What case brought about the PSDA and involved the supreme court? What was the finding?
Nancy Cruzan
Ethically and legally acceptable in the USA to withdraw/withhold treatment for adults with decisional capacity.
What does the Ethical Religious Directives say about Withholding/Withdrawing treatment?
Patients with decision making capacity have a right to refuse life sustaining treatments.
Patients who lack decision making capacity have the same rights to refuse; the rights are exercised through a decision maker.
There is no ethical difference between
How does the principle of double effect come into play with pain medication and death?
ERD states: It is ethically acceptable to provide medication sufficient to control a patient's pain and symptoms even in the rare circumstance in which this intervention may foreseeably hasten the patient's death.
How do ERDs compare Withdrawing/Witholding treatment and suicide, euthanasia, or physician assisted suicide?
Forgoing life sustaining treatment is ethically and legally distinct from suicide, from euthanasia, and from physician assisted suicide.
What is the standard used by an appointed surrogate (including one from the Health Care Surrogate Act)?
Best interest standard (same as for minors):
- What is best for the incompetent patient who lacks decisional capacity?
Define Medical Futility
Therapeutic treatment will have little or no medical effect, AND MAY CAUSE HARM
Why is MedicalFutility difficult for caregivers?
Because family or patient will demand that "everything" be done.
WHo more foten requets that "everything" be done, the family or the patient?
The family
What is palliative care?
Comfort care
Cessation of any aggressive treatment
WHo is palliative care for?
Terminal and non-terminal patients
What is a form of palliative care?
Hospice
Do we need consent to do a DNR?
No a doctor can order a DNR without a patient's consent, but it is often with a patient's consent
When is it difficult to identify if a patient is DNR?
Outpatient setting or in the patient's home when EMS arrives.
What does ERD say about feeding tubes?
Medically assisted food and nutrition becomes morally optional if it becomes excessively burdensome.
What is ERD 32?
While every person is obliged to use
ordinary
means to preserve his or her health, no person should be obliged to submit to a health care procedure that the person has judged, with a free and informed conscience, not to provide a
reasonable hope of benefi
In "How to die in Oregon" what was the conflict of interest with insurance companies?
Some were willing to pay for PAS, but not for further treatment (Poor guy taking radio out of car, angry about the letter)
PAS involves how many stakeholders?
Two. The doctor has to write the prescription for the medication.
Around how many of those who got the medication followed through with suicide?
~60%
Why would some patients get the medication but not go through with the procedure of suicide?
Sometimes they just like having it there as an option
What is unique about a Practitioner Orders For Life-Sustaining Treatment (POLST)?
It is a form of an advanced directive, A physician from a different hospital can order it and it will be honored by all hospitals in the state.
Which of the four principles (of the HCP) was the most prominent in the documentary about PAS?
Benefecince
How does the Oregon PAS law correlate with the ANA provisions?
Respect for autonomy, provision 1?