CT Bioethics & End-of-Life Decisions 3 — Questions and Answers
Question 1: The Terri Schiavo case highlighted which central bioethical conflict?
- The right of physicians to override family decisions
- Tension between surrogate decision-making authority and state interest in preserving life (Correct answer)
- Federal government control over state medical licensing boards
- The role of insurance companies in end-of-life care
Correct answer: Tension between surrogate decision-making authority and state interest in preserving life
Schiavo exemplified the conflict between a spouse-surrogate's right to withdraw life support and state legislation attempting to override that decision in favor of preserving life.
Question 2: A thanatologist is consulted when a Muslim family refuses autopsy for their deceased relative. The medical examiner requires autopsy due to unclear cause of death. Which framework best guides this conflict?
- The thanatologist should override religious objection citing public health law
- Cultural humility combined with institutional legal counsel to explore legally permissible alternatives (Correct answer)
- Immediate deferral to the family's wishes without consulting the medical examiner
- Standard hospital ethics committee review replacing legal authority
Correct answer: Cultural humility combined with institutional legal counsel to explore legally permissible alternatives
Cultural humility acknowledges religious concerns while legal consultation identifies whether exceptions or alternatives (imaging, external exam) satisfy statutory requirements.
Question 3: Which of the following actions is most consistent with the ethical principle of nonmaleficence in end-of-life care?
- Continuing aggressive treatment because family insists
- Discontinuing a painful procedure that offers no clinical benefit (Correct answer)
- Informing patients of all available experimental treatments
- Ensuring equitable resource allocation across all patients
Correct answer: Discontinuing a painful procedure that offers no clinical benefit
Nonmaleficence requires avoiding harm; discontinuing a burdensome, benefit-free procedure directly prevents ongoing suffering without therapeutic gain.
Question 4: The Patient Self-Determination Act (PSDA) of 1990 requires healthcare facilities that receive Medicare/Medicaid funding to:
- Provide palliative care consultations to all admitted patients
- Inform patients of their right to make advance directives upon admission (Correct answer)
- Obtain written advance directives before performing elective surgery
- Appoint a hospital ethics committee to review all end-of-life cases
Correct answer: Inform patients of their right to make advance directives upon admission
The PSDA mandates that covered facilities inform patients at admission of their right to accept or refuse treatment and to complete advance directives.
Question 5: In the context of informed consent for end-of-life decisions, 'decisional capacity' requires that the patient:
- Hold a college degree and speak English fluently
- Understand information, appreciate consequences, reason about options, and communicate a choice (Correct answer)
- Be evaluated by a psychiatrist within 48 hours of any major decision
- Have a legally recognized surrogate available as backup
Correct answer: Understand information, appreciate consequences, reason about options, and communicate a choice
Decisional capacity has four components: understanding, appreciation, reasoning/deliberation, and communication of a stable choice.
Question 6: When a terminally ill patient requests palliative sedation to unconsciousness (PSU), the primary ethical justification is:
- The patient's wish to hasten death by any available means
- Relieving refractory suffering when no other intervention adequately controls symptoms (Correct answer)
- Reducing the emotional burden on the clinical care team
- Lowering end-of-life costs for the healthcare system
Correct answer: Relieving refractory suffering when no other intervention adequately controls symptoms
PSU is ethically justified by the principle of beneficence—relieving intractable, refractory suffering that cannot be controlled by other palliative measures.
Question 7: Which concept describes the ethical obligation of clinicians to treat all dying patients with equal care regardless of social status, diagnosis, or cultural background?
- Beneficence
- Veracity
- Justice (Correct answer)
- Fidelity
Correct answer: Justice
Justice in bioethics demands fair and equitable distribution of care and resources, prohibiting discrimination in end-of-life treatment.
CT Bioethics & End-of-Life Decisions 3
The Terri Schiavo case highlighted which central bioethical conflict?