CT Bioethics & End-of-Life Decisions 2 — Questions and Answers
Question 1: A patient with terminal cancer loses decision-making capacity after previously refusing a feeding tube. The surrogate insists on tube feeding. Which ethical principle most directly supports honoring the patient's prior refusal?
- Beneficence
- Autonomy (Correct answer)
- Justice
- Nonmaleficence
Correct answer: Autonomy
Autonomy respects the patient's right to make decisions about their own body, including prior directives that remain binding after capacity is lost.
Question 2: In the doctrine of double effect, which criterion distinguishes permissible palliative sedation from euthanasia?
- The patient must consent to hastened death
- The harmful effect must not be the means to the good effect (Correct answer)
- The physician must be board-certified in palliative care
- Family members must unanimously agree to the treatment
Correct answer: The harmful effect must not be the means to the good effect
Double effect requires that harm (hastened death) be a foreseen but unintended side effect, not the mechanism through which relief is achieved.
Question 3: A 78-year-old patient with advanced dementia has no advance directive. Her adult children disagree about withdrawing ventilator support. What is the ethically preferred decision-making standard when intent cannot be determined?
- Physician substituted judgment
- Best interests standard (Correct answer)
- Family majority vote
- Institutional ethics board override
Correct answer: Best interests standard
When prior wishes are unknown, the best interests standard guides surrogates to choose what a reasonable person in the patient's situation would want.
Question 4: Which legal document specifically allows a person to designate someone else to make healthcare decisions on their behalf if incapacitated?
- Living will
- POLST form
- Durable power of attorney for healthcare (Correct answer)
- Do-not-resuscitate order
Correct answer: Durable power of attorney for healthcare
A durable power of attorney for healthcare (healthcare proxy) legally designates an agent to make medical decisions when the person lacks capacity.
Question 5: Medical futility is most accurately defined as treatment that:
- Costs more than the patient's insurance will cover
- Cannot achieve the patient's physiological or goals-of-care objectives (Correct answer)
- Has not been approved by the FDA for end-of-life use
- Is refused by more than one consulting specialist
Correct answer: Cannot achieve the patient's physiological or goals-of-care objectives
Medical futility means the intervention will not achieve the intended physiological goal or the patient's defined goals of care, not merely that it is expensive or unapproved.
Question 6: A dying patient requests that clinicians not disclose a terminal prognosis to family members. The family separately demands full information. Whose right takes ethical precedence?
- The family's, because they will manage post-death affairs
- The patient's, because confidentiality and autonomy belong to the patient (Correct answer)
- The physician's, because clinical disclosure is professional judgment
- The hospital's, because institutional policy supersedes individual wishes
Correct answer: The patient's, because confidentiality and autonomy belong to the patient
Confidentiality and autonomy vest in the patient; clinicians may not disclose protected health information to third parties without the patient's consent.
Question 7: Physician Aid in Dying (PAID) differs from voluntary active euthanasia primarily in that:
- PAID requires terminal illness while euthanasia does not
- In PAID the patient self-administers the lethal medication, not the physician (Correct answer)
- PAID is legal in all 50 US states while euthanasia is federally banned
- Euthanasia requires psychiatric evaluation while PAID does not
Correct answer: In PAID the patient self-administers the lethal medication, not the physician
In PAID the physician prescribes the medication but the patient performs the final act of ingestion; in euthanasia the physician administers the lethal agent.
CT Bioethics & End-of-Life Decisions 2
A patient with terminal cancer loses decision-making capacity after previously refusing a feeding tube.
The surrogate insists on tube feeding.
Which ethical principle most directly supports honoring the patient's prior refusal?