Determination of Death / Informed Consent
WEEK 6: DETERMINATION OF DEATH / INFORMED CONSENT
1. Uniform Determination of Death Act (UDDA): is a model state law that was approved for the United States in 1981 by the National Conference of Commissioners on Uniform State Laws, in cooperation with the American Medical Association, the American Bar Association, and the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. a. How this law was created: The act has been adopted by most US states and is intended "to provide a comprehensive and medically sound basis for determining death in all situations".
b. Legal definition of death: Death is defined as the ending of life or the total and permanent cessation of all vital functions of the body including the heartbeat, brain activity (including the brain stem), and breathing. The UDDA offers two definitions for when an individual may legally be declared dead:
A) Irreversible cessation of circulatory and respiratory functions; or
B) Irreversible cessation of all functions of the entire brain, including the brain stem.
2. Define dying within context of faith, basic principle about human life.
With faith we should believe that we have being created for eternal life with the union of God. With our faith believed that we will continue to live with Christ after our death on earth, the death of the physical body.
3. Pain Management / Relief.
“Patients should be kept as free of pain as possible so that they may die comfortably and with dignity, and in the place where they wish to die”. To keep the patient in dignity we should administer pain medication to the dying patient when needed to alleviate their pain, make them comfortable but not with the intent to speed up death. At this point of life, pain medication should be given as often as the patient request it, with spiritual support to allow the process to be more human, peaceful and comfortable as well as the opportunity to receive the sacraments in order to prepare well for death.
4. Pain and suffering. Explain difference
Pain is more at the physical experience and psychological. On the other hand, suffering is mostly psychological, emotional and spiritual level. Suffering may or may not be connected to physical pain.
5. Diagnosis / prognosis: define both.
Diagnosis: means an identification of a condition by observation of symptoms, it is the current state of the patient. Diagnosis will lead to a protocol, a method of care.
Prognosis: refers to a prediction of the course and outcomes of a condition. Therefore, once a professional makes a diagnosis, they might then make a prognosis based on the likely course of an illness.
6. Ordinary / Extraordinary means of life support. Explain and bioethical analysis.
Ordinary means of life support: medical procedures that offer adequate or reasonable benefits without excessive or undue burdens to the patient and family, it can reasonably be expected to improve a seriously ill person's condition. On a bioethical view the ordinary means of life support is proportionate, we are obligate to offer the medical support if it will ameliorate the patient life.
Extraordinary means of life support: is defined as any medical procedure or measure which, when administered to a terminally ill patient, will only prolong the process of dying when death is imminent, but excludes palliative care. In a way or others human organ will fail one day, so we are not obligate to replace every organ if the result won’t prolong the patient life but will prolong their death. Therefore, on a bioethical view the extraordinary means of life support is disproportionate, we are not obligate to offer life support since the result is just prolonging the patient death.
7. Killing or allowing to die? Define both and explain which one is ethically correct and why?
Killing is active action that someone is doing to trigger death, meanwhile “allowing to die” is more passive where you let nature take over allowing the person to die peacefully in dignity. Not having an active role or precipitating the death of a patient by using other means is ethically more acceptable. No one should kill, it is a major sin for whoever does it. Since death is inevitable for every human being, we should allow a patient to comfortably die as nature demand but not trigger it chemically.
8. Catholic declaration on life and death; give a summary of this document: https://ecatholic-sites.s3.amazonaws.com/17766/documents/2018/11/CDLD.pdf
It is a legal document that assign a surrogate, living will and carrying out the patient wishes at the end of life. They should continue to provide medical assistance, nutrition assistance if the patient is incapacitated. Spiritual care should be provided including sacrament whenever possible. It is signed by the patient, surrogate and two witnesses.
9. What is a free and informed consent from the Catholic perspective?
The free and informed consent of the person or the person’s surrogate is required for medical treatments and procedures, except in an emergency when consent cannot be obtained. Also, requires that the person or the person’s surrogate receive all reasonable information about the proposed treatment and its benefits; its risks, side-effects, consequences, and cost; and any reasonable and morally legitimate alternatives, including no treatment at all. The free and informed health care decision of the person or the person’s surrogate is to be followed so long as it does not contradict Catholic principles.
10. Define Proxy, Surrogate
A healthcare proxy is a document (legal instrument) with which a patient (primary individual) appoints a representative to legally make healthcare decisions on behalf of the patient, when he or she is incapable of making and executing the healthcare decisions stipulated in the proxy.
A healthcare surrogate is someone appointed to make healthcare decisions for you when you become unable to make them for yourself. You have no control in who becomes your healthcare surrogate.
11. Explain: a. Advance Directives: a written statement of a person's wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should the person be unable to communicate them to a physician. b. Living Will: is a document that explains whether or not you want to be kept on life support if you become terminally ill and will die shortly without life support, or fall into a persistent vegetative state. It also addresses other important questions, detailing your preferences for tube feeding, artificial hydration, and pain medication in certain situations. A living will become effective only when you cannot communicate your desires on your own. c. PoA / Durable PoA: A power of attorney (POA) legally assigns authority to someone to act on your behalf in matters that you specify within the document. A durable power of attorney automatically extends the duration of the POA in the event you are mentally incompetent at the time it will expire. d. DNR: Do not resuscitate (DNR), or no code, is a legal order written either in the hospital or on a legal form to withhold cardiopulmonary resuscitation (CPR) or advanced cardiac life support (ACLS), in respect of the wishes of a patient in case their heart were to stop or they were to stop breathing.
References:
*Retrieved from https://www.youtube.com/watch?v=WdGqUeIJVes BIO 603 3 17 18
*Retrieved from: https://www.youtube.com/watch?v=GWpHn2_a-eU&t=295s BIO 603 CONSENT 4 6 19
* Ethical and Religious Directives for Catholic Health Care Services, 6th Edition. (2018) U.S. Conference of Catholic Bishops. Washington, DC. (ERD 24, 25, 26, 27, 28, 55, 59, 61, 62).
*Retrieved from: https://ecatholic-sites.s3.amazonaws.com/17766/documents/2018/11/CDLD.pdf