Case-based clinical ethics education

End-of-Life Care

How do we determine what a patient would have wanted?

The AMA’s Summary on End-of-Life Options

Read the AMA’s chapter summarizing opinions on end-of-life care options:

https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/code-of-medical-ethics-chapter-5.pdf

An excellent summary including sections on Advance Care Planning, Advance Directives, Withholding or Withdrawing Life-Sustaining Treatment, Orders Not to Attempt Resuscitation (DNAR), Medically Ineffective Interventions, Sedation to Unconsciousness in End-of-Life Care, Physician-Assisted Suicide, and Euthanasia (AMA consensus for latter two is that they are fundamentally incompatible with a physician’s role as healer)


The Bitter End

Make Your Wishes Known

Listen to WNYC Studios Radiolab’s podcast The Bitter End:

This highlights the discrepancies between patient vs doctor’s expectations on life-saving interventions, which becomes especially evident in the survey of what a doctor would want done for themselves in the case of irreversible brain damage.


Read this Atlantic article featuring Dr Kenneth Prager, director of Clinical Ethics at Columbia, on how a family understandably thought their loved one would not want to live as a quadruple amputee, but turned out to be wrong:

https://www.theatlantic.com/health/archive/2013/07/make-your-wishes-known/277654/



There’s More to Medical Ethics Than Absence of Harm

Read the following Huffington Post article:

https://www.huffpost.com/entry/take-care-theres-more-to_b_7461616

How should one help determine a patient’s wishes at end of life?  How much potentially distressing information should a doctor disclose?  What if there’s a conflict between medical vs personal ethics?


References:

American Medical Association. (2016). Chapter 5: Opinions on Caring for Patients at the End of Life. Published in AMA Principles of Medical Ethics: I, IV. Retrieved from https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/code-of-medical-ethics-chapter-5.pdf

WNYC Studios. (2013, January 15). The Bitter End. Retrieved from https://www.wnycstudios.org/story/262588-bitter-end

Masoodi, A. (2013, July 10). Make Your Wishes Known. Retrieved from https://www.theatlantic.com/health/archive/2013/07/make-your-wishes-known/277654/

Kodish, E. (2015, May 29). Take Care: There’s More to Medical Ethics Than Absence of Harm. Retrieved from https://www.huffpost.com/entry/take-care-theres-more-to_n_7461616