Chapter 6 Quality of life

1. Chapter 6 Quality of life

2. Quality of life is the third topic that must be reviewed in order to analyze a problem in clinical ethics. • Any discussion of quality of life necessarily involves medical indications and patient preferences.

3. The most fundamental goal of medical care is the improvement of quality of life for all those who need and seek care, and also relief of pain and improvement of function. • All activities, such as examining, evaluating, diagnosing, treating, curing, comforting and educating, aim at improving the patient’s quality of life.

4. Meaning of quality of life • It expresses a value judgment: the experience of living, as a whole or in some aspect, is judged to be “good” or “bad”, “better” or “worse”.

5. In recent years, efforts have been made to develop measures of quality of life that can be used to evaluate outcomes of clinical interventions. • Such measures list a variety of physical functions, such as mobility, performance of activities of daily living, absence or presence of pain, social interaction, and mental acuity.

6. In general, quality of life can be defined as a multidimensional construct that includes “performance and enjoyment of social roles, physical health, intellectual functioning, emotional state, and life satisfaction or well-being.”

7. Quality-of –life judgments must consider personal and social function and performance, symptoms, prognosis, and the individual, often unique values that patients ascribe to the quality of their life.

8. Several important questions: • who is making the evaluation—the person living the life or an observer? • What criteria are being used for evaluation? • What types of clinical decisions are justified by reference to quality-of- life judgment?

9. Enhancing quality of life • Recently, medical skills have been used to improve on normal conditions：cosmetic surgery responds to the desires of individuals for a more beautiful appearance, administration of growth hormone increases height for persons of short stature……

10. the distinction between treatment and enhancement: • Treatment attempt to respond to physical, physiologic, or psychological defects that deprive persons of normal characteristics. • Enhancement are made in response topatient preference and to improve quality of life.

11. palliative care and treatment of pain • Palliative care medicine is defined as “an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

12. Relief of pain is a traditional medical goal. • Increasingly, palliative care medicine deals with pain and suffering at the end of life. • Palliative care medicine uses methods to achieve global aims: aiding patients to deal with their impending death and its effect on others.

13. pain relief for terminally ill patients • Palliative care includes skilled application of pain-relieving drugs. • Competence in palliative care includes not only science and skill in managing pain but also understand and application of ethical principles.

14. Patient should not be kept on a drug regimen inadequate to control pain because of the ignorance of the physician

15. Attempt to achieve adequate pain relief have another side effect, namely, the clouding of the patient’s consciousness and the hindering of the patient’s communication with family and friends. • This consequence may be distressing to patient and family and ethically troubling to physicians and nurses.

16. Instead, sensitive attention to patient’s needs, together with skilled medical management, should lead as close as possible to the desired objective: maximum relief of pain with minimal diminution of consciousness and communication.

17. Euthanasia • Another word for euthanasia is mercy killing. • Euthanasia literally means ’good death’ and generally aims to hasten the death of people who suffer severely without any hope of recovery.

18. Voluntary euthanasia: When the person who is killed has requested to be killed. • Non-voluntary euthanasia: When the person who is killed made no request and gave no consent.

19. The act of euthanasia is today understood as termination of life on request. • But it has not always been people’s choice. • The voluntary decision to terminate life has been misused during the human history, especially between 1933 and 1945 during the German Nazi regime in Europe.

20. This criminal regime murdered millions of people because they were disabled, ill, old, or of different ethnic group. • Murders committed for these reasons were also called “euthanasia”. • Nazi regime excused their criminal deeds as termination of “worthless lives”. • This is against the humane nature of love and compassion, and equal human rights.

21. Assisted suicide: Someone provides an individual with the information, guidance, and means to take his or her own life with the intention that they will be used for this purpose.

22. Physician Assisted Suicide: When it is a doctor who helps another person to kill themselves.

23. Euthanasia By Action: Intentionally causing a person's death by performing an action such as by giving a lethal injection.

24. Euthanasia By Omission: Intentionally causing death by not providing necessary and ordinary (usual and customary) care or food and water.

25. The crimes committed in the past are one of the reasons why termination of life on request is a criminal act in almost all States of the world. • In the Netherlands voluntary euthanasia has been decriminalised. • This made the Netherlands the first country in the world to formally sanction mercy killing. (Belgium, Oregon)

26. Under the new law, euthanasia is administered only to patients who are in a state of continuous, unbearableandincurable suffering. • There are other requirements as well: • A second opinion from an external physician; • The patient must be judged to be of sound mind; • A request to die must be made voluntarily, independently and persistently.

27. These are NOT euthanasia: • Not commencing treatment that would not provide a benefit to the patient. • Withdrawing treatment that has been shown to be ineffective, too burdensome or is unwanted. • The giving of high doses of pain-killers that may endanger life, when they have been shown to be necessary.

28. Care of the dying patient • Attention to relief of pain and discomfort and enhancement of the patient’s ability to interact with family and friends become predominant goals. • Hospice care and palliative medicine work to achieve these goals. • Cure sometimes, support frequently, comfort always.

29. Quality end-of-life care requires: • Appropriate control of pain and symptoms; • Avoid inappropriate prolongation of dying; • Enhance the control of patients over their care; • Rest with family; • Supported by physicians, nurses, and social workers.