CT End-of-Life Care & Support 3 — Questions and Answers
Question 1: Which federal law in the United States established the right of patients to create advance directives and be informed about them upon hospital admission?
- The Health Insurance Portability and Accountability Act (HIPAA)
- The Patient Self-Determination Act (PSDA) of 1990 (Correct answer)
- The Emergency Medical Treatment and Labor Act (EMTALA)
- The Americans with Disabilities Act (ADA)
Correct answer: The Patient Self-Determination Act (PSDA) of 1990
The PSDA of 1990 mandated that healthcare facilities receiving Medicare/Medicaid funding inform patients of their right to create advance directives.
Question 2: A thanatologist is supporting a patient from a cultural background where decisions are traditionally made collectively by the family rather than the individual. The most culturally competent approach is to:
- Insist on individual autonomy as the only ethical framework
- Explore the patient's own preferences about decision-making roles (Correct answer)
- Exclude the patient from family discussions entirely
- Automatically transfer decision-making authority to the eldest family member
Correct answer: Explore the patient's own preferences about decision-making roles
Cultural competence requires exploring each patient's individual preferences, which may or may not align with collectivist cultural norms.
Question 3: The Physician Orders for Life-Sustaining Treatment (POLST) differs from a standard advance directive primarily because it:
- Is a legal document that only attorneys can prepare
- Constitutes actual medical orders that must be followed by emergency responders (Correct answer)
- Replaces all other forms of advance care planning
- Is only valid in inpatient hospital settings
Correct answer: Constitutes actual medical orders that must be followed by emergency responders
POLST is a medical order set, not just a directive, making it immediately actionable by emergency medical services and other healthcare providers.
Question 4: Which of the following best describes the role of a thanatologist in an interdisciplinary hospice team?
- Prescribing pain medications and managing medical symptoms
- Providing grief support, education, and psychosocial care to patients and families (Correct answer)
- Overseeing the financial aspects of hospice care billing
- Making all end-of-life medical decisions on behalf of the patient
Correct answer: Providing grief support, education, and psychosocial care to patients and families
Thanatologists contribute psychosocial, educational, and grief support expertise to interdisciplinary teams, complementing medical and nursing care.
Question 5: Palliative sedation at end of life is ethically distinguished from euthanasia primarily by:
- The dose of medication used
- The intention—relieving suffering vs. causing death (Correct answer)
- The patient's level of consciousness afterward
- Whether the family consents to the procedure
Correct answer: The intention—relieving suffering vs. causing death
The doctrine of double effect holds that palliative sedation aims to relieve refractory suffering, not hasten death, distinguishing it ethically from euthanasia.
Question 6: A family member tells the hospice team, 'We need to keep fighting—giving up is wrong.' This statement most likely reflects:
- A clinical assessment that curative treatment is still possible
- Cultural or personal values equating acceptance with abandonment (Correct answer)
- A formal request to transfer care to an acute hospital
- Denial of the terminal prognosis due to misinformation
Correct answer: Cultural or personal values equating acceptance with abandonment
Many families interpret moving to comfort care as 'giving up,' reflecting deeply held values about fighting, loyalty, and what it means to love someone.
Question 7: Which of the following is a key indicator that a patient may benefit from a hospice referral under Medicare's hospice benefit criteria?
- The patient is over the age of 65
- A physician certifies a prognosis of six months or less if the disease runs its normal course (Correct answer)
- The patient has already exhausted all insurance benefits
- The patient has a diagnosis of cancer specifically
Correct answer: A physician certifies a prognosis of six months or less if the disease runs its normal course
Medicare hospice eligibility requires two physicians to certify a terminal prognosis of six months or less if the illness runs its normal course.
CT End-of-Life Care & Support 3
Which federal law in the United States established the right of patients to create advance directives and be informed about them upon hospital admission?