Question

1. Decision-making to place a DNR order on a patient's record should include which of the following considerations (check all that apply):

Select one or more:

a. Four to six minutes after cardiac arrest, or loss of circulation, the brain suffers significant damage, with resulting cognitive deficits, and if it is not performed quickly enough, CPR may result only in the rescue of a severely brain-damaged individual.

b. A decision for "full code" ("Attempt CPR") or "no code" (DNR/DNAR) should be weighed carefully against the patient's overall condition, health, prognosis, and goals of treatment.

c. Elderly patients subjected to CPR often suffer secondary injuries, including cracked ribs, broken sternum, and damage to internal organs.

d. The success rate for in-hospital CPR attempts is very low, particularly for elderly patients, where success is defined as "surviving to discharge with baseline neurological function intact."

e. CPR promises very different results for different patients, dramatically helping some and burdening others.

2. The Uniform Determination of Death Act, 1981, established federal guidelines for states to follow in passing legislation regarding the legal definition of death. Please identify the definitions (or criteria) of death that are recognized by the UDDA and all 50 states---check all that apply:

Select one or more:

a. "Higher brain death" (or "neocortical" brain death), meaning, an individual is dead if she suffers the irreversible loss of consciousness, due to massive damage to the cerebral hemispheres.

b. "Brain stem death," meaning, an individual is dead if she suffers the irreversible loss of function of the entire brain, except for minimal brain stem function, even if it is sufficient to support respiration.

c. "Cardiopulmonary death," meaning, an individual is dead if she suffers irreversible cessation of circulatory and respiratory function.

d. "Brain death," or "whole brain death," meaning, an individual is dead if she suffers the irreversible loss of function of the entire brain, including the brain stem.

e. "Coin toss death," meaning, heads you're still with us, tails you're gone.

3. Even the most careful advance directive can be difficult to apply in a given set of circumstances, due to vagueness, ambiguity, lack of relevance to the patient's actual (vs. anticipated) illness, and so forth, making ethics consultations necessary, regardless of the patient's planning.

Select one:

True

False

4. Some critics of advance directives are skeptical that a competent individual can rightly decide his own future best interests, once he has become incompetent; the personality and personal-identity changes are so radical, as aging and disease progress, that the future incompetent person will have a distinct identity from the competent person now making plans for him. Thus, those plans have no ethical basis, no more than those that I might make for you, without your permission.

Select one:

True

False

5. The patient's right to provide informed consent to treatment has been recognized in contemporary times, as an expression of respect for patient autonomy as an ethical principle, as well as an extension of the legal right to self-determination over one's own body; however, the patient's right to refuse treatment---especially life-sustaining treatment without which she would die---has not yet gained significant acceptance in bioethics nor legal recognition in the courts.

Select one:

True

False

6. Which of the following individuals was at the center of the court case in which the US Supreme Court first accepted the principle that patients capable of making medical decisions have a right to refuse life-sustaining treatment under the due process clause of the Constitution and the common law principle of informed consent?

Select one:

a. Nancy Cruzan

b. Robert Wendland

c. Karen Ann Quinlan

d. Terri Schiavo

7. Advance directives, allowing people to document their treatment preferences just in case they become incapacitated, typically take two forms: Living wills, in which the patient records treatment preferences relative to different possible conditions, illnesses, or treatment options; and health care proxy appointments, in which the patient nominates another person to make decisions on her behalf, according to her known wishes and best interest.

Select one:

True

False

Answer 1

ANSWER :

1.Option a ,b and e

a- 4 to 6 minutes after cardiac arrest , or loss of circulation or brain suffers sufficient damage , which result in cognitive deficits and if it is not prrformed quicly enough CPR may result in rescue of severely brain damaged individual

• 6 minutes after cardiac will lead to death of heart muscle and brain death which reduces survival rate of patient to 30 to 20 % , where CPR is of no use.

b-A decision for "full code"(attempt CPR ) or "no code"(DNR or DNAR ) should be weighed carefully against the patients overall condition , health ,prognosis and goals of treatment

e-CPR promises very different results for different patients , dramatically helping some and burdening others.

2.Option c and d

Reason :

Criteria for death according to UDDA:

• Irreversable cessation of circulatory and respiratory functions(cardipulmonary death)
• Irreversable cessation of all functions of brain including brain stem ( whole brain death).