Ethics

Question 1

What are the 5 key components of ethical practice?

Answer 1

• decisions should be based on knowledge
• patients individual beliefs should be taken into account
• hazards should be described
• lack of efficacy should be admitted
• uncertainties should be acknowledged

Question 2

When are ethics particularly important?

Answer 2

• when the efficacy of the treatment is uncertain (in relation to physiological functioning and QoL)
• if patient is unable to communicate decisions
• uncertain what LIFE implies (i.e. are they likely to be living a highly restricted life?)

Question 3

Who can communicate the benefit of life to the patient? How do you decide who to treat?

Answer 3

1) the patient. This overrides any family beliefs
2) The family/clinical team
- who to treat: easy when consensus is gained from both teams of QoL, but difficult when this is not the case and the treatment has the POTENTIAL to improve QoL

Question 4

The WHO definition for the meaning of life

Answer 4

a state of biological functioning where the individual derives a personal benefit

Question 5

Autonomy of the patient and the right to refuse treatment

Answer 5

• Drs can refuse treatment if patient requests a therapy which is not clinically proven to be efficacious
• Patients can ALWAYS refuse treatment
• BUT in cases where minors, parents make decisions, but if not in best clinical interest, Drs can take to court appeal
• Drs can also refuse treatment for ‘social handicaps’ i.e. tattoo removal as not under the remit of medical care

Question 6

Nutrition and terminal care: what is ethical?

Answer 6

• everybody has a right to food and water, but artificial nutrition is seen as a medical therapy and can be refused
• supplying nutrition and hydration in terminal care may prolong suffering and is not pursued if the patient is seen to be in a process worse than death
• gastronomy tubes only used if the patient will benefit from the nutrition and may improve QoL