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the entire state of the living thing; the element of autonomy through which a person experiences a sense of self:
what are the two greatest, most fundamental goals of healthcare?
- the preservation of life
- the mantainence of quality of life
what are the two main points of disagreement in differing beliefs about the "entire state" of life?
- when life actually begins
- the way life ends
name four essential traits that may be considered as elements of a quality life:
- physical functioning
- psychological status
- social functioning
- disease or treatment symptomology
the idea that "all natural" life has intrinsic meaning and should be appreciated as a divine gift:
sanctity of human life
the act of knowlingly ending one's life:
name and define/give an example of the two forms of suicide:
- active: physically bringing about one's own death
- passive: refusing treatment when it will knowingly cause death
in our profession, assisting or supplying the means to suicide is:
deliberately ending the life of another to end suffering:
ending of another person's life by an aggressive method to end suffering:
ending of another person's life by withdrawing treatment:
euthanasia has become an accepted procedure in:
the topic of euthanasia is the most controversial in which cases?
- handicapped neonates
- elderly patients
- patients in PVS
- incompetent patients
- senile patients
the ability to grow and continue the life process:
the expulsion or removal of a (usually nonviable) fetus:
what does new research show in cases of patients in vegetative states?
they sometimes have the ability to think and communicate
according to some British and Belgian studies utilizing high-tech MRIs that measure brain activity, how many PVS patients may be able to communicate, statistically?
one in five
according to studies of communicability of PVS patients, what three thought processes are the patients exhibiting when they successfully communicate?
- comprehension of instructions
- comprehension of speech
- making a decision
the inability to make decisions:
list the five stages of grief when dealing when facing death:
who defined the accepted stages of grief in dealing with death?
Elizabeth Kublur Ross
the idea of lethal injections often invokes perception of physicians as:
- "doctors of death"
- "angels of mercy"
of the two which generally encompasses more and which is generally more specific, the advance directive or the living will?
- encompasses more: advance directive
- more specific: living will
_______________ identify specific treatments to be initiated or discontinued when patients become terminally ill, are in great pain, or find themselves in a life-threatening situation.
explain three functions of ethics committees:
- to serve in an advisory capacity to both providers and families
- to educate the hospital, its employees, and other constituencies
- to develop policies regarding problem areas
name some services that provide aid to terminally ill patients (6):
- hospice care
- home health care services
- mental health services
- social services
- organizations for persons with specific terminal diseases
- pastoral and religious services
the principle that competent patients have a right to forego
life-sustaining treatment was not articulated by any court until:
the _________________________ became effective and requires all health care institutions receiving medicare or medicaid funds to inform patients that they have the right to refuse medical/surgical care and the right to initiate a written advance directive.
Patient Self Determination Act of 1991
the contemporaneus cessation of heart and lung function:
the heart-lung definition of death
give the new accepted alternative to the heart-lung definition of death:
brain death - no brainstem activity controling the heart and lungs to the point that the patient will not be able to breath on their own
give some criteria that determine "brain death":
- lack of response to stilumi
- lack of reflexes
- absent respiration
- isoelectric electroencephalogram that, for at least 30 minutes, will not change in response to sound or painful stimuli
what practice rendered the heart-lung definition of death inadequate?
successful organ transplantation techniques
a condition of severely altered consciousness in which minimal but definite behavioral evidence of self-awareness or environmental awareness is demonstrated:
minimally conscious state
a condition in which higher brain function is lost, but the brainstem continues to function:
persistant vegetative state (PVS)
a law put forth that states that an individual who has sustained either irreversible cessation of circulatory and respiratory functions or irreversible cessation of all functions of the entire brain, including the brainstem, is dead.
uniform determination of death act of 1980 (UDDA)
who makes the declaration of death?
what type of standards is the declaration of death governed by?
medical, not legal
when did the states adopt statutes for living wills, and when were further guidelines established for the durable power of attorney?
allows doctors to prescribe lethal medications to end the lives of patients thought to be terminally ill who desire to end their lives:
Oregon Death with Dignity Act
what is the AMA's position on the subject of physician assisted suicide?
it would do more harm than good and the physician must aggressively respond to the needs of the patient
name three tools that can be used before incompetency takes place:
- living will
- durable power of attorney
- declaration relating to life-sustaining treatment and durable power of attorney for health care decisions
if the physician does not want to carry out the requests of patients with living wills he/she must:
transfer the patient to a professional who will carry out their wishes
name two terms given to describe illegal practices of staff members providing "resuscitation" that is guaranteed to be unsuccessful:
- "slow codes"
- "pencil DNRs"
what is DNR and what is DNI?
- DNR: do not resuscitate
- DNI: do not intubate
who may execute a living will?
anyone can execute a living will at any time; however, it must be notarized OR signed by two witnesses to be legal
since each state has different regulations, where is the best place to get a living will?
from the medical facility or a lawyer
a ___________ is a document executed by a competent person (known as ___________ ) to appoint another (known as ________ ) to make health care decisions when the first person becomes incompetent.
- durable power of attorney
- the principal
- the agent
some states utilize ________________________ which allow appointed family members to make decisions when no advance directive exists.
family consent laws
a statute formulated that takes a comprehensive approach by placing into one statute: the living will, the durable power of attorney, family consent law, and some provisions involving organ donation:
Uniform Health Care Decisions Act of 1993
know the order of the Uniform Health Care Decisions Act of 1993 hierarchy:
- the patient (if competent)
- the patient , through an individual instruction (ex. living will)
- an agent appointed by the patient in a written power of attorney for healthcare
- a guardian appointed by the court
- a surrogate appointed orally by the patient
- a surrogate selected from a list of family members and others who can make healthcare decisions on behalf of patient
name two tests courts have used to determine whether treatment may be withdrawn in the absence of advance directives:
- based on the strength of patient communication when competent
- based on the condition of the patient
what is the standard that is most often used in cases of patients who have never been competent?
the "best interest" standard
list some illegal treatments of the living will that may give rise to civil or criminal liability:
- coercing someone into signing a living will
- destroying or hiding a living will
- forging another person's living will
- failing to record the existence of a living will
- making medical care or health insurance coverage conditional on the existence of a living will