End of life - Ethics

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Questions and Answers

Who is primarily responsible for pronouncing death if a patient dies under care?

Medical students on duty

Emergency response teams

The attending physician (correct)

Registered nurses in hospice settings

What does the term 'Dead on Arrival' (DOA) signify?

The patient died during transport to the hospital

The patient shows obvious signs of being deceased (correct)

The patient is unresponsive but alive upon arrival

The patient has passed away before being pronounced by a doctor

What is the ethical guideline regarding pain management for patients with a history of drug abuse?

High doses of medication should be avoided

Pain management should never be withheld (correct)

Only alternative therapies should be used

Pain management should be strictly limited

In end-of-life care, what is the main ethical consideration regarding pain control?

Suffering from pain should be minimized at all costs Signup and view all the answers

Which of the following best describes the responsibilities of surrogate decision-makers?

They should make decisions consistent with the patient's wishes Signup and view all the answers

What distinguishes advance care directives from living wills or healthcare proxies?

They apply regardless of the patient's decision-making capacity. Signup and view all the answers

Who is typically recognized as a next of kin surrogate decision-maker?

A close family member, like a spouse or parent. Signup and view all the answers

What is entailed by a DNR order?

No attempts to resuscitate the patient should be made. Signup and view all the answers

What does withholding treatment mean?

Choosing not to start a treatment that is deemed inappropriate. Signup and view all the answers

What is a key responsibility of physicians regarding patient information?

To provide all relevant information about advanced treatments to patients and decision-makers. Signup and view all the answers

What is meant by withdrawing treatment?

It involves stopping a treatment that is currently being provided. Signup and view all the answers

At what point should a patient's code status be confirmed?

At each hospital admission, regardless of previous status. Signup and view all the answers

Which of the following best describes the role of a surrogate decision-maker?

To advocate for decisions in the best interest of the incapacitated individual. Signup and view all the answers

What determines a patient's preferred course of treatment if they are unable to make decisions themselves?

Advance directives or surrogate decision-maker Signup and view all the answers

What is a key ethical distinction between withdrawing treatment and physician-assisted suicide?

Withdrawing treatment halts treatment while physician-assisted suicide actively causes death. Signup and view all the answers

Which of the following statements about the rights of patients regarding treatment decisions is true?

Patients have the right to refuse any treatment at any time. Signup and view all the answers

What is the primary ethical consideration when making decisions for patients in a persistent vegetative state (PVS)?

Best interests of the patient based on advance directives Signup and view all the answers

Which of the following is a crucial factor in the decision to withdraw treatment?

Potential risks and burdens of treatment Signup and view all the answers

In which circumstances might a patient be approved for hospice or palliative care?

If they have a limited life expectancy and decide to withdraw treatment Signup and view all the answers

What is a critical role of surrogate decision-makers in healthcare?

To represent the patient's wishes when they cannot decide Signup and view all the answers

What has the U.S. Supreme Court established regarding physician-assisted dying?

It is dependent on state laws and regulations. Signup and view all the answers

What is the primary advantage of a living will compared to a healthcare proxy?

It clearly communicates the patient's own wishes. Signup and view all the answers

In the absence of both capacity and advance directives, what is the best course of action?

Use a healthcare proxy or a living will if available. Signup and view all the answers

What is a significant challenge of using a living will?

It requires knowledge of specific medical treatments. Signup and view all the answers

What ethical principle underlies the use of living wills and healthcare proxies?

Autonomy, valuing the patient's own expressed wishes. Signup and view all the answers

Which statement is true regarding patients with life-threatening illnesses and advance directives?

The majority of patients lack formal advance directives. Signup and view all the answers

What is a potential benefit of a healthcare proxy compared to a living will?

It provides more flexibility in decision-making. Signup and view all the answers

During the decision-making process, what must be clear for a living will to be useful?

The living will must be specific and clear regarding treatments. Signup and view all the answers

What common misconception do patients have regarding advance directives?

They believe all physicians are aware of their directives. Signup and view all the answers

What standard of evidence is generally applied by courts for withholding or withdrawing artificial nutrition?

The same as that required in criminal cases Signup and view all the answers

Which of the following statements reflects the ethical consensus regarding artificial nutrition and hydration (ANH)?

ANH decisions should follow the same standards as other medical treatments. Signup and view all the answers

What is a significant ethical stance on physician-assisted suicide in the context mentioned?

It is never considered ethically acceptable, regardless of legality. Signup and view all the answers

What might be deemed a necessary condition before withholding nutrition from an unconscious patient who left no instructions?

Convincing evidence that the patient did not wish to be fed Signup and view all the answers

How do certain states differ in their treatment of withholding or withdrawing artificial nutrition compared to other medical treatments?

They impose more stringent standards. Signup and view all the answers

What ethical principle supports the right of a patient to stop medical treatment they no longer wish to pursue?

Autonomy Signup and view all the answers

In the context of physician-assisted suicide, which is always considered true?

It remains ethically unacceptable irrespective of state law. Signup and view all the answers

What principle does the caution exercised in decisions about withholding nutrition reflect?

Preservation of life and avoiding wrongful death Signup and view all the answers

In the context of withholding treatment, what is the main consideration for a competent adult?

The potential benefits vs. burdens of the treatment Signup and view all the answers

What is an important consideration for physicians regarding end-of-life decisions?

Ensuring decisions are made to respect patient autonomy and wishes. Signup and view all the answers

What should a physician respect if a patient with chronic obstructive pulmonary disease (COPD) requests to stop mechanical ventilation?

The patient's informed decision to stop treatment Signup and view all the answers

What is a significant ethical distinction between withholding and withdrawing treatment?

There is no ethical distinction; both are the patient's rights Signup and view all the answers

Which of the following statements about physician-assisted suicide is most accurate in certain jurisdictions?

It is considered an extension of the right to refuse treatment Signup and view all the answers

What is typically required for a competent adult to legally refuse artificial nutrition?

A clear understanding of the implications of their decision Signup and view all the answers

In the context of end-of-life decisions, what does the term 'withholding treatment' primarily refer to?

Deciding against initiating a particular treatment Signup and view all the answers

Which of the following factors can influence state laws on end-of-life decisions?

All of the above Signup and view all the answers

Study Notes

Advance Care Directives

Advance care directives are independent of a patient's decision-making capacity at the time of application
Advance Care Directives are different from living wills or healthcare proxy appointments

Surrogate Decision Makers

A surrogate decision-maker is appointed to make medical or legal decisions on behalf of an incapacitated individual.
The surrogate decision-maker is typically a close family member, such as a spouse, adult child, or parent.
Their role is to ensure medical treatments and decisions align with the incapacitated individual's wishes and best interests

Physician Duties

Physicians must provide all information about their patients’ conditions.
Physicians should provide detailed information to patients and their decision-makers about advanced medical treatments that can be used during end-of-life care

Code Status

Full code: make all efforts to resuscitate
DNR: do-not-resuscitate order
DNI: do-not-intubate order
A patient's code status should be documented and confirmed with the patient or surrogate at each hospital admission.
A patient's code status may be unknown at the time vital interventions are necessary

Withholding vs Withdrawing Treatment

Withholding treatment is deciding not to initiate or start a particular treatment.
Withdrawing treatment is ceasing or discontinuing a treatment that is currently being provided.

Pronouncing Death

The physician typically pronounces death and records the time of death.
In certain states, some registered nurses can pronounce death.
Emergency response teams may pronounce a person "Dead on Arrival" (DOA) if criteria are met (e.g., obvious postmortem changes or injuries incompatible with life).

Pain Management

Pain control at end-of-life care is essential.
It is acceptable to give high doses of pain medication that may inadvertently facilitate end of life.
Never withhold adequate pain management.

Refusal of Treatment

Patients with decision-making capacity (or their surrogate) have the right to refuse any form of treatment at any time.
Physicians should understand the reasons behind a patient's decision to refuse treatment.
Patients who opt to withdraw from treatment and have limited life expectancy may be approved for hospice care/palliative care.

Persistent Vegetative State (PVS)

The decision to maintain a patient in PVS depends on their advance directive or surrogate decision-maker.

Medical Aid in Dying

Physician-assisted dying involves the physician providing medication, intervention, or information to a patient to enable or accelerate death.
Physician-assisted dying is illegal in most states.
The U.S. Supreme Court has ruled that the laws of physician-assisted death are to be decided on a state-by-state basis.

Withholding and Withdrawal of Artificial Nutrition

The level of evidence required to withhold or withdraw artificial nutrition has been compared to evidentiary standards in criminal cases.
Similar to criminal cases, the system errs on the side of caution. It would be preferable to withhold nutrition in a questionable case rather than potentially allowing someone to die who may have wished otherwise.
It is generally accepted that decisions about providing or withholding artificial nutrition and hydration (ANH) for patients lacking capacity should be made based on the same standards as any other medical treatment.
Some states have stricter standards for withholding or withdrawing ANH compared to other medical treatments.

Physician-Assisted Suicide

Physician-assisted suicide is considered ethically unacceptable even when it is legal.
The physician provides the means for the patient to end their own life.
The physician does not administer the substance that ends the patient's life.

Withholding and Withdrawal of Medical Treatment

Every competent adult has the right to decide which medical treatments they receive.
There is no ethical or legal distinction between withholding and withdrawing medical treatment.
A patient's right to refuse treatment applies whether it is a new treatment or a treatment they have already received.

Advance Directives

Living wills are a form of advance directive that can overrule family wishes.
Living wills are difficult to make comprehensive because it is hard to predict which medical treatments may be required in the future.
A health-care proxy can provide more flexibility in decision-making.
If a patient has written out specific conditions and treatments, a living will can be useful.

Decision-Making for Patients Without Capacity

An adult with capacity can make their own decisions about treatment.
An adult without capacity can have their decisions made by a health-care proxy or living will if it is clear and specific.
Most patients, even elderly or terminally ill patients, lack a formal advance directive.
This often makes decision-making difficult.

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Description

This quiz covers essential concepts surrounding advance care directives, surrogate decision-makers, physician duties regarding patient information, and code status classifications. It is designed to enhance understanding of crucial end-of-life decisions and the responsibilities of healthcare professionals in these scenarios.