What is curing?
The alleiation of symptoms of the termination or suppresion of a disease process
What is healing?
A gradual awakening to a deeper sense of self in a way that effects profound change
Why is end of life care talked about more now?
Technology
What are the four paradigms of dying in our culture today?
- Death is a natural part of life
- The medicalizatinon of dying
- Palliative medicine/hospice
- Death on demand
What are the four conclusions of the SUPPORT study?
- poor symptom management
- Inconsistent with patient preferences and values
- Problematic communication and decision making
- Life-prolonging, intensive treatments vs palliative care
What is the first question to ask for a patient at the end of life?
What are their goals
Is technology neutral or the cause of end of life issues?
Neutral–it’s how we use it
When evaluating modalities of treatment, what five things must be assessed?
- Risks
- benefits
- burdens
- probability
- harm
What is the recommended method of feeding patients with end stage dementia?
oral assistance
What are the steps of the “goals of care” conversation?
- Review situation
- Asscess decision maker’s understanding
- Establish goals
- Present options
- Weigh risks/benefits
- Measure effects of decision on loved ones
- Off additional resources
- Provide ongoing support
What does 6-6-6-6 thing mean?
What was person like 6 month, weeks, days, hours ago
What are the three questions that shold be asked when withholding/withdrawing resuscitation?
- Avoid death?
- Prolong life?
- Define success
What is the difference between euthanasia and physician assisted suicide?
Euthanasia = dr kills Assisted = dr supplies means
Are euthanasia or physician assissted suicide legal in the U.S.?
Euthanasia, no
PAS = in some states
What is non-voluntary euthanasia?
Pt did not consent or request death
What is passive euthanasia?
Erroneuous term, that means to let pt die
What are the ethical cons of euthanasia in terms of social justice?
May devalue marginalized
What are the three established practices of euthanasia?
- Voluntary, informed refusal of treatment by pt
- Withhold/withdraw based on best interests
- Palliative and hospice care
What are the four controversial issues in terms of euthanasia?
- Voluntarily stopping intake
- Palliative sedation
- PAS
- Pt/surrogate demand futile therapies
Does the use of opioids hasten death?
No–breathing happens long after earlier symptoms develop
What are the four principles of double effect?
- Nature of the act
- Agent’s intentions
- Distinction between means and effects
- Proportionality b/t good effect and the bad effect
What does the “nature of the act mean” in terms of the principle of double effect?
The act has to be good or at least morally neutral
What does the “agent’s intentions” mean in terms of the principle of double effect?
Agent must intend only good. Bad effects can be foreseen and tolerated, but NOT INTENDED.
What does the “distiction between means and effects” mean in terms of the principle of double effect?
bad effect must not be a means to a good effect
