1 Part 2 Bioethics Midterm

COLEGIO SAN AGUSTIN-BACOLOD
COLLEGE OF HEALTH AND ALLIED PROFESSIONS

B.S. Aquino Drive, Bacolod City
NCM 108
HEALTH CARE ETHICS
BIOETHICS AND ITS APPLICATION IN VARIOUS

HEALTH CARE SITUATIONS
ARLENE GEVERO OROPEL, RN, MN – CSA-BACOLOD

Dignity in Death and Dying
▪ Dysthanasia
▪ Orthothanasia
▪ Administration of Drugs to the Dying
▪ Advance Directives
▪ DNR or End of Life Care Plan
Dignity in Death and Dying - Terminologies

•Euthanasia - Greek words “eu” (good) and “thanatos” (death). The idea is that
instead of condemning someone to a slow, painful, or undignified death,
euthanasia would allow the patient to experience a relatively “good death.”
•Dysthanasia (Greek: dus; "bad, difficult, thanatos; "death") refers to the practice
of prolonging the life that are seriously or even terminally ill and that are
potentially experiencing suffering
▪Orthothanasia Greek orthós (right) and thánatos (death) “correct death”
▪Palliative -
DIGNITY IN DEATH AND DYING:
DYING WITH DIGNITY = THE
MOVEMENTS THAT PROMOTES
THE ABILITY TO MEET DEATH ON
YOUR OWN TERMS.
Dying with
dignity
Suicide Euthanasia – a Doctor is

Which is also called physician allowed by the law to end
assisted suicide- is when the
person’s life by painless
doctor gives the person the
means to commit suicide when means as long as the patient
requested for. and their family agrees
▪ DYSTHANASIA
▪When framing and analyzing dysthanasia from the

perspective of a medical act, it can be understood as :
an attitude of excessive treatment in relation to the
clinical condition and its expected prognosis
DYSTHANASIA
▪Another plain and basic definition would be one that

considers a prescribed treatment that offers no
feasible chance of obtaining any benefit for the patient.
You give a loƚ of ƚreaƚmenƚ buƚ ƚhaƚ doesn͛ƚ acƚually
affect ƚhe paƚienƚ͛s progress.
DYSTHANASIA
▪An impediment to this definition is that it is a subjective

definition that has the extremely delicate task of
demarcating the two sides, namely, life and death. Such a
decision cannot rest on the subjective reasoning of the
decision maker
DYSTHANASIA
▪You are pushing a lot of intervention. It is the

counteract of euƚhanasia͘. Iƚ is a form of abuse in a way
but iƚ͛s actually putting efforts in a way, even though
there will be no desirable effect
DYSTHANASIA
▪When considering reasoning with the three (3)
components of medical procedure:
1. Diagnosis ʹ what is it about, what is the cause, what is really
the condition/disease.
2. Treatment ʹ how to treat, what are the medical/nursing
treatment that will put into it to cure the disease.
3. Prognosis ʹ chances of desirable outcome
Dysthanasia can be considered as a deviation from a

medical actʹ since considering the deontological precepts,
treatments considered the expected prognosis. If the
prognosis is bad, slim, there is no point in continuing the
treatment. Just giving the person a dignified death.
deontological
ORTHONASIA
Orthonasia - refers to the art of promoting a humane
and correct death, not subjecting patients to
misthanasia or dysthanasia and not abbreviating
death either, that is subjecting them to euthanasia.

Euthanasia Orthothanasia Dysthanasia

It is the interruption Aims to promote a It is the institution of futile
of the natural course dignified death, without measures with the consequent
of life. the imposition of futile prolonging of the patient’s
measures, seeking comfort suffering in palliative care.
and quality of life
To abbreviate death It is natural death. It is the opposite of euthanasia,

or the dying process. this means, the prolonging of
life, even with a prognosis that is
inconsistent with life.
To forcefully It is to let death follows its Useless prolonging of the
anticipate death. natural course, without patient’s life, since there is no
artificially increasing the possibility of reversing the
The doctor leads the Technique performed on Cases in which the

patient to death terminally ill patients, made prognosis is of incurable
with the patient’s and or the and irreversible diseases,
family’s consent. The procedures and the patients’ lives are
and relief measures to keep the prolonged.
patient alive are suspended, but
palliative care that will help
control pain is provided
To end a patient’s To minimize suffering, to not Prolonging suffering,
suffering. To perform futile therapy, to therapy without relieving
disconnect the provide support for palliative or patient’s pain.
patient from terminal care.
intensive therapy.

To eliminate pain and Providing palliative care Painful and useless life
chronic illness, to patients until the time extension.
stopping suffering of death.
Practice of giving Middle ground between Act of prolonging life,

comfort during the the two other even when it is known
terminal phase of a definitions: it would be that the patient’s death is
patient whose disease to let death happen inevitable.
knowingly has no cure. without any kind of
Corresponds to assisted interference.
death

A mechanism by which Continuous assistance that It is to delay
death is induced by drugs grants palliative care, even if it death by all
or other means. does not bring hope of cure means, even
and only eases the pain, without hope of
allowing death to come cure.
naturally.
The key word here is:

palliative care
It is a great opportunity for terminally ill patients

to keep their dignity where there is a commitment
to the well-being of the patient in the final phase
of the disease.
In order to give the dignity of dying, we have to

make them comfortable, feel that they lived a
good life. It is not just about the physiologic make
up of a person, also look into the deal of the
person when it comes to those cases.
▪Ethical decisions inspire trust and with-it fairness,

responsibility and care for others.
The ethical decision making process recognizes
these conditions and requires reviewing all available
options, eliminating unethical views and choosing the
best ethical alternative. x
Administration of Drugs to the Dying: Palliative sedation

▪ induces a coma-like state when symptoms such as pain,
nausea, breathlessness, or delirium cannot be controlled
while a patient is conscious. This state is maintained until
death occurs.
▪the nurse must involve and support the family but also
ensure that the patient's room is peaceful and quiet. The
family may, if they wish and feel it is appropriate, be
involved in caring for the patient.
Administration of Drugs to the Dying: Palliative sedation

▪Is palliative sedation ethical? The ethical principle of
beneficence demands that clinicians provide care that will
benefit the patients and promote their well-being. As
such, the relief of suffering is an ethical action.
▪In medicine, for the end life care, palliative sedation is of
choice of relieving distress in last days/last hours of
terminally ill lives. Continuous intravenous or
subcutaneous infusion of sedative drugs.
Administration of Drugs to the Dying:

▪Palliative sedation is an option of last resort for patients life
whose symptoms can not be controlled by only other
means(including pain, delirium, dyspnea, and severe psychological distress)
▪This is not in a form of euthanasia as the goal of palliative
sedation is to control symptoms rather than to shorten patient’s
life.
Advance Directives- Advance Care Planning in the Philippines

▪is yet to recognize the concept of advance directives.
▪lack knowledge about advanced care planning and do not discuss
this with their physicians.
▪As a family-oriented group of people, Filipinos often rely on their
relatives for decisions.
▪Advance care planning, especially end-of-life matters, should be
discussed while you are still in good health and of sound mind.
▪ hospitals still honor these documents.
Advance Directives:
Types of Advance Directive Forms
1. Healthcare Power of Attorney
2. Living Will
Nursing roles and responsibilities:

▪Treat people compassionately
▪Communicate clearly and sensitivity
▪Identify and meet the communication needs of each
individual.
▪Acknowledge pain & distress & take action
▪Recognize when someone maybe entering the last few
days/hours of life.
Nursing roles and responsibilities:

▪ Document a summary of conversation and decisions
▪Seek further advice if needed.
▪Learning from complaints
▪Keep the person who is reaching the end of their life and
those important to them up to date with any changes in
condition.
▪Involve people in decisions about their care & respect their
wishes.
▪Listen to people
Advance Directives:
▪are written instructions to your healthcare providers.
▪these are established before the need for medical
intervention.
▪ they help ensure your providers respect your autonomy
when you cannot express your wishes.
▪it guides healthcare professionals and family members on
how to proceed with life-sustaining interventions.
Advance Directives:
1. Healthcare Power of Attorney (Durable Power of Attorney or Health Care
Proxy)
▪is an advance care directive that lets you choose another person to make
healthcare decisions for you in the future.
▪It will be carried out when you are incapacitated, in order to respect
your wishes regarding your health.
▪“principal,” -client, “agent.” - person you choose to make decisions
Advance Directives:
Principal Agent
• you may give your agent • would be required to honor your wishes and
specific instructions about follow any detailed instructions you give
your care preferences. regarding the care you want to be provided or
withheld.
• can write your own • cannot be your healthcare provider.
• clear and consistent • could be a significant other, friend, or relative, as
choices if your condition long as you trust them to carry out your wishes
is terminal and incurable.
• advocate for you during end-of-life.
• essential to consider if they are easily reachable by
email, phone, or text.
Advance Directives:
2. Living Will -are legal documents with specific requirements that need to be
followed to be legally effective.(18yo with sound mind, 2 witnesses, notarized)
▪use to declare your wishes to refuse, limit, or withhold life-sustaining
treatment.
▪It can only take effect if you have a terminal condition and are incapacitated
or unable to communicate your preferences for care.
▪know what medical interventions you may or may not want to receive to
sustain your life like:
▪ CPR, Ventilation –Respiratory Machine, Dialysis, Pain medications, Artificially provided
nutrition and hydration by tube or other medical means
DNR or End of Life Care Plan:
▪ End of life care includes PALLIATIVE CARE:

• If you have an illness that can not be cured , based on
understanding that DEATH is inevitable.
• Makes you as comfortable as possible by managing your
pain and other distressing symptoms
• It also involves psychological, social, and spiritual support
for you and your family or careers.

•A Do Not Resuscitate (DNR) order means that CPR (
CARDIO-PULMONARY RESUSCITATION ) is not to be
conducted in case of cardiac or respiratory arrest.
•Important ethical values described by the participants
were to avoid doing harm and to secure a peaceful and
“natural” death with dignity for their dying patients. A
preference for the expression “allow for natural death”

▪can be part of your living will
▪can also be written in your medical chart by your physician.
▪A DNR does not equate to “Do Not Treat.”
▪means that your healthcare providers will not perform
cardiopulmonary resuscitation (CPR) should your heart stops or
your breathing ceases.
▪only effective in a hospital setting or when an individual is on hospice care.

▪antibiotic therapy, blood transfusion, use of a ventilator, and
other treatments that can prolong life will still be provided unless
indicated in another advance directive.
▪A claim for DNR should always be accompanied by a legal
medical document for the reference of emergency personnel.
▪There are two general types of DNR orders: DNR Comfort Care
(DNR-CC) orders and DNR Comfort Care-Arrest (DNR-CCA)
orders
DNR-CC- “DO NOT RESUSCITATE- DNR-CCA –” DO NOT RESUSCITATE-
COMFORT CARE” COMFORT CARE ARREST”
orders require that only comfort care be This order permits the use of life-saving
provided even before the patient’s interventions, such as chemotherapy, curative
breathing or heart stops. surgery, or medication, up until one’s breathing
or heart stops; after this point, only
interventions relating to one’s comfort are
permitted
This type of order is typically used in the Basically, CPR will not be provided, but
case of a short life expectancy or physicians are still expected to provide the
terminal illness where curative patient with comfort care to the best of their
treatment does not prove to be abilities.
D
DO NOT RESUSCITATE- DNR-CC
“COMFORT CARE” * STATE OF FLORIDA 1DNR
DO NOT RESUSCITATE- DNR CC-A *STATE OF OHIO 2DNR
“ COMFORT CARE - ARREST”
** PHILIPPINES 2 DNR
**VARIES IN EVERY STATES
• Inotropic agents, or inotropes, are medicines that change the force of your heart's contractions. 2 kinds of inotropes: positive
DNR or End of Life Care Plan:- COMFORT

•Hold your loved one's hand:
ooffer very gentle massage as long as that seems to be soothing
to her.
•Create a quiet environment:
• Turn off the television
• ask visitors to take their conversations to another room
• remove the telephone and minimize outside sounds that may
come in through the windows.

•Sit in silence
• This work can be fostered by simply sitting next to the
person in silent
• support and with thoughts of love. use prayer.
• The dying person may appear to be asleep but often there
is a great deal of “inner work” taking place as she
processes any unfinished business from the past and let go
of attachments to life.

• Speak soothing words:
ospeak softly and use words that help him with his inner work of letting
go. You can remind him that you love him
o that he has lived a good life, you will remember him, and it’s okay for
him to let go when he is ready.
•Dim the lighting:
oBright lights can be disturbing to a dying person,
ouse a few small lamps in the room to create softer illumination

•Keep the patient’s mouth moist:
oThe body begins to dehydrate during the dying process, This
simple gesture can make a huge difference in your loved one’s
comfort level during the final days of life.
•Play soft music:
odying patients respond well to soft background music, which can
enhance relaxation and ease anxiety.
•Use gentle touch:
oListen and observe carefully to help you recognize when
something is causing discomfort or when there is a need for your
closeness

•Be ready to provide whatever gentle kindness you are called upon
to offer and trust that you will know instinctively what to do when
a need arises.
Author: Karen Wyatt

▪What Really Matters: 7 Lessons for Living from the Stories of the Dying
▪A Family Physician (most to hospices)
Source:
McAdam, Jennifer L., et al. Attitudes of Critically Ill Filipino
Patients and Their Families toward Advance Directives.
American Journal of Critical Care, vol. 14, no. 1, Jan. 2005,
pp. 17–25, doi:10.4037/ajcc2005.14.1.17.

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COLEGIO SAN AGUSTIN-BACOLOD

COLLEGE OF HEALTH AND ALLIED PROFESSIONS

BIOETHICS AND ITS APPLICATION IN VARIOUS

ARLENE GEVERO OROPEL, RN, MN – CSA-BACOLOD

Dignity in Death and Dying

Dignity in Death and Dying - Terminologies

Suicide Euthanasia – a Doctor is

▪When framing and analyzing dysthanasia from the

▪Another plain and basic definition would be one that

▪An impediment to this definition is that it is a subjective

▪You are pushing a lot of intervention. It is the

Dysthanasia can be considered as a deviation from a

and correct death, not subjecting patients to

misthanasia or dysthanasia and not abbreviating

death either, that is subjecting them to euthanasia.

Euthanasia Orthothanasia Dysthanasia

To abbreviate death It is natural death. It is the opposite of euthanasia,

Euthanasia Orthothanasia Dysthanasia

The doctor leads the Technique performed on Cases in which the

Euthanasia Orthothanasia Dysthanasia

Practice of giving Middle ground between Act of prolonging life,

Euthanasia Orthothanasia Dysthanasia

The key word here is:

It is a great opportunity for terminally ill patients

In order to give the dignity of dying, we have to

▪Ethical decisions inspire trust and with-it fairness,

Administration of Drugs to the Dying: Palliative sedation

Administration of Drugs to the Dying: Palliative sedation

Administration of Drugs to the Dying:

Advance Directives- Advance Care Planning in the Philippines

Types of Advance Directive Forms

1. Healthcare Power of Attorney

Nursing roles and responsibilities:

Nursing roles and responsibilities:

DNR or End of Life Care Plan:

▪ End of life care includes PALLIATIVE CARE:

DNR or End of Life Care Plan:

DNR or End of Life Care Plan:

DNR or End of Life Care Plan:

DNR or End of Life Care Plan:- COMFORT

DNR or End of Life Care Plan:- COMFORT

DNR or End of Life Care Plan:- COMFORT

DNR or End of Life Care Plan:- COMFORT

DNR or End of Life Care Plan:- COMFORT

Author: Karen Wyatt

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