Beruflich Dokumente
Kultur Dokumente
Euthanasia
o An act in which a physician directly assists a patient in dying,
usually via lethal injection
Palliative Sedation
o Combination of double effect and withdrawal of treatment
o Proportionate palliative sedation
More common, generally accepted
Intent is to preserve alertness as much as possible
o Palliative Sedation to unconsciousness
More controversial (esp. if hastening death), should be
rare, may be needed for extreme suffering
o Uses benzos or barbiturates for sedation with opioids for pain
o Patient usually dies from dehydration
o Should require 2nd opinions (palliative care, ethics)
o Recognizes there are limits to palliative care
o Should rarely be used
Futility
o Quantitative futility (statistical definition)-the requested
treatment is unlikely to benefit
o Physiological futility-requested treatment is not working or is
known not to work
o Qualitative futility-the goal is not worth achieving-whats the
point?
o Who decides on what is futile?
Medically ineffective treatment-means that, to a
reasonable degree of medical certainty, a medical
procedure will not:
Prevent or reduce the deterioration of the health of
an individual; or
Prevent the impending death of an individual
o How to decide what is medically ineffective?
case-by-case evaluations using a fair process approach
is likely the best option
When can a life-sustaining treatment be withheld or withdrawn
from adults?
o Patient or proxy in agreement
The care is something that the patient would not want
Doesnt have to be medically ineffective; may work
physiologically but wont change course of events (ex. Abx
when dying from cancer)
o Patient or proxy not agreeing
Consensus on poor medical prognosis
Is medically ineffective, or burden of continued care
exceeds expected benefits
Comparative worth is not a factor in the decision
Advance Care Planning
Feeding Tubes
Conditions where feeding tubes are likely helpful (these can also be
possibly helpful depending on the patients physical state, mental
state, goals of patients, what patient considers to be a good quality of
life)
o Short bowel syndrome
o Short-term critical care stay
o CVA
o Brain Injury
o Radiation therapy/ chemo in proximal GI tract / Head and Neck
Cancer
o Abdominal cancers (stomach) with proximal GI obstruction
o
Conditions where feeding tubes are likely not helpful
o Advanced Dementia
o Advanced Parkinsons disease
o Advanced cancer with cachexia
Avoiding tube feeding does not mean taking away food
Careful hand feeding provides human contact and can help maintain
weight and intake
Feeding tubes can cause pain and distress for people with advanced
dementia
When dementia reaches end-stage, feeding efforts can focus on
comfort and human interaction more than nutritional goals
Justice
Equals should be treated equally and unequals unequally
Belmont Report
Ethical Principles and Guidelines for the Protection of Human Subjects
of Research (respect for persons, beneficence, justice)
Justice in Research
Vulnerable populations lack the capacity to make informed and free
decisions about participation in research
They should not be overrepresented
They should not be underrepresented
They should have equitable access to benefits of research
Vulnerable Populations
Children
Economically Disadvantaged
Cognitively Impaired
Terminally Ill (?)
Prisoners, Students, Military
Ethnic and Minority Populations
Pregnant Women (?)
Developing World Nations
Theories
Each according to need whoever needs it the most, gets it first
Greatest good greatest number we take the resource & do as
much with it
Generational Reciprocity I have already taken my share, so I
have to leave resources for other people
First come first serve
lottery
Fair Inning
Immunization
herd effect
if we can keep enough people vaccinated, we prevent public health
issue
Organ Transplantation
we try to avoid moral judgements when distributing sources
Blood type and other medical factors weigh into the allocation of every
donated organ, but, other factors are unique to each organ-type
you have to be sick to quality for also be able to benefit from it
Live Donation
Ethical Issues:
o Consent from Donors
Voluntariness
Family Members, Minors
McFall v. Shimp, 10 Pa. D. & C. 3d 90 (July 26, 1978)
Harm to Donor
o How much is too much?
Confidentiality of Recipient
Motives of Donor
o Money, Fame, Beneficence
o Payment to Donors
o Reimbursement for Donors
Sarah Murnaghan
Media Sensationalism
Religious Objections
Pandemic Planning
forces us to think what we would do in these situations
a pandemic is a global disease outbreak
how do you distribute things if everyone is affected at once?
Issues:
o Which groups to prioritize for vaccine or antiviral medications?
(medical providers, military, police, vaccine manufacturersbut
then go gets it after that?) => greatest good greatest
number
o How to ration medicines, healthcare services, equipment, and
basic supplies?
o Limitations on personal freedoms: social distancing, closing
schools, bans on social gatherings (even religious), quarantine,
bans on travel..
The duty to care issue could be challenged. Staff and
physicians will struggle with the issue of personal safety and well
being as they deal with the threat of exposing themselves and their
families to contagion
Abortion
Roe v. Wade made abortion legal in the US
o the states were forbidden from outlawing or regulating any
aspect of abortion performed during the first trimester of
pregnancy
o could only enact abortion regulations reasonably related to
maternal health in the second and third trimesters
o and could enact abortion laws protecting the life of the
fetus only in the third trimester. Even then, an exception
had to be made to protect the life of the mother
Planned Parenthood vs. Casey
o the state may ban abortion after fetal viability as long as
exceptions were made to protect the womans health or life.
o Allows for state to require parental notification if a minor seeks
an abortionbut there must be a judicial process in place for
adolescents to seek approval through the courts rather than
their parents (except if married, graduated from HS or
emancipated in WV)
Conscientious Objection
the refusal to perform a legal role or responsibility because of personal
beliefs.
alert colleagues & patients
you cant abandon the patient (you have to find someone else)