Deck 6: End-Of-Life Issues and Decisions

Question 1

The case of Terry Schiavo was compounded by the fact that

A) her husband argued that she was conscious, and not in a PVS (persistent vegetative state).
B) the U.S. Supreme Court declined to grant judicial review.
C) she was subpoenaed to testify at a congressional "field hearing."
D) she had not completed her advance directive.

Answer 1

D

Question 2

Three principles of medical ethics are

A) competence, information, non-maleficence.
B) autonomy, beneficence, justice.
C) impartiality, prognosis, support.
D) public acceptance, honesty, freedom.

Answer 2

B

Question 3

All of the following occurred with Karen Ann Quinlan EXCEPT

A) Quinlan's parents requested that she be removed from a mechanical respirator.
B) the request of Karen's parents was opposed by the hospital officials and resulted in a judicial suit.
C) the Supreme Court of New Jersey ruled in favor of the hospital officials and Karen remained on the respirator.
D) Karen's case became the focal point for issues pertaining to "death with dignity".

Answer 3

C

Question 4

A study in 1961 found that, ________ doctors had a strong tendency to withhold information.

A) few
B) most
C) military
D) hospital-based

Question 5

Currently, physician-assisted death is permitted by legislation enacted in

A) California and Colorado.
B) Vermont, Hawaii and Washington D.C.
C) Oregon and Washington.
D) All of the above.

Question 6

What disorder of consciousness has been characterized as "awake but unaware" and also has been called "hopelessly conscious"?

A) Coma
B) Vegetative state
C) Locked-in syndrome
D) Minimally conscious state (MCS)

Question 7

What is a fundamental principle in medical care which is the injunction to "do no harm"?

A) Nonmaleficence
B) Beneficence
C) Assistance
D) Etiologically

Question 8

What position did the state of Missouri initially take in the Nancy Beth Cruzan case?

A) It contended that Nancy's parents did not have the right to remove artificial feeding.
B) It contended that the medical center did not have the right to remove Nancy's feeding tube.
C) It deferred to federal law requiring Nancy to be sustained by artificial feeding.
D) It deferred to medical professionals to determine Nancy's fate.

Question 9

The controversy surrounding the Karen Ann Quinlan case centered on the

A) abuse of prescription drugs.
B) separation of church and state.
C) issue of transplantation.
D) right to forgo life-sustaining treatment.

Question 10

By acknowledging the inevitability of death we

A) can prepare for it.
B) become sad and worried.
C) are more open to near death experiences.
D) may divest of financial burdens.

Question 11

"DNR" at end-of-life refers to the orders of

A) Do Not Receive.
B) Do Not Recall.
C) Do Not Resuscitate.
D) Do Not Recharge.

Question 12

Ethical questions regarding the "right to die" first came to public attention in the landmark court case involving

A) Nancy Beth Cruzan.
B) Karen Ann Quinlan.
C) Nancy Ellen Jobes.
D) Elizabeth Bouvia.

Question 13

Studies of the Oregon Death with Dignity Act show that the decision to request a prescription for lethal medication was associated mainly with patients' concerns about loss of dignity, loss of ability to have an enjoyable life, and loss of

A) cognitive functioning.
B) independence in toileting.
C) youthful looks.
D) autonomy.

Question 14

What is a fundamental principle in medical care which involves doing good or conferring benefits that enhance personal or social well-being?

A) Autoficence
B) Comfort measures only (CMO)
C) Beneficence
D) Medical heroics

Question 15

What is a state of profound unconsciousness lasting a few days or weeks?

A) Persistent vegetative state
B) Minimally conscious state
C) Coma
D) Post-coma unresponsiveness

Question 16

What year did informed consent achieve formal legal definition?

A) 1929
B) 1945
C) 1957
D) 1963

Question 17

Informed consent ideally occurs within a context where the

A) health-care provider will decide what is best.
B) patient and health-care provider share in decision making.
C) patient decides whether to follow the advice of the doctor.
D) patient seeks a second opinion.

Question 18

In which of the following is the individual's right to autonomy violated?

A) An older woman who refuses to undergo back surgery
B) An older man whose physician and family coerce him to have foot surgery
C) An infant whose parents elect for surgery to correct a congenital heart defect
D) An athlete who seeks a second opinion based on his coach's suggestion

Question 19

Patients at the end of life may not want disruptive medical interventions. The preference can be recognized in a medical setting by designating the patient as

A) prognosis and preferences
B) tacit communications.
C) comfort measures only.
D) withhold and withdraw.

Question 20

Informed consent is based on a patient's competency to give consent, adequate understanding of proposed treatment, and

A) faith in the doctor's advice.
B) consent must be given freely.
C) appropriateness of treatment goals.
D) the agreement of family or close friends.

Question 21

Which industrialized countries are identified in the text as permitting euthanasia to patients who request death?
1) United States and Japan
2) Netherlands and Belgium
3) Belgium and Luxembourg
4) United Kingdom and Japan

A) 1 and 2
B) 2 and 3
C) 1 and 4
D) 2 and 4

Question 22

A living will allows an individual to

A) describe the things they want to do before they die.
B) refuse life-sustaining treatment in the event he or she is terminally ill.
C) communicate instructions to their family for estate and funeral planning.
D) require a physician to keep them alive at all costs.

Question 23

Which state became the first to adopt a Natural Death Act giving legal recognition to the living will?

A) California
B) Florida
C) New Jersey
D) New Mexico

Question 24

A codicil relates to

A) rewriting a will.
B) amending a will.
C) making an oral will.
D) formalizing a will.

Question 25

According to Barton Bernstein, the second legal stage in cases of terminal illness involves which of the following activities?

A) Deliver the will for probate
B) Survivors obtain sufficient funds to cover immediate expenses
C) Notify the attorney and insurance representatives
D) Medical personnel being notified if the dying patient intends to make an organ donation or anatomical gift

Question 26

What is the condition when a person dies without having left a valid will?

A) Intestate
B) Attestation
C) In holographic
D) Testator

Question 27

Which act allows physicians to prescribe lethal medication to terminally ill patients?

A) California Patient Compassion Act (CPCA)
B) Oregon Death with Dignity Act (DWDA)
C) United States Terminal Sedation Act (USTSA)
D) New York Samaritan Death Act (NYSDA)

Question 28

According to Barton Bernstein, the first legal stage in cases of terminal illness

A) occurs immediately after the patient dies.
B) involves the patient in long-range planning and arranging legal and financial affairs.
C) involved writing one's Five Wishes.
D) involves delivering the will for probate.

Question 29

Euthanasia comes from the Greek

A) quick death.
B) easy death.
C) forever sleep.
D) deliberate death.

Question 30

What document combines a living will and a health care power of attorney?

A) Double Power Will
B) Physician Order for Life-Sustaining Treatment
C) Viatical settlement
D) Five Wishes

Question 31

Which organization created the Five Wishes document?

A) Aging with Dignity
B) Florida Bar Association
C) American Medical Association
D) American Association of Retired Persons

Question 32

The conventional written legal document used for specifying a person's wishes for the distribution of his or her estate after death is a/an

A) ethical will.
B) nuncupative will.
C) formally executed will.
D) testament.

Question 33

In the medical management of pain, what rule states that a harmful effect of treatment, even if it results in death, is permissible if the harm is not intended and occurs as a side effect of a beneficial action?

A) Oregon Death with Dignity rule
B) Rule of double effect
C) Euthanasia rule
D) Rule of beneficence

Question 34

An advanced directive is best defined as

A) any statement made by a competent person about choices for medical treatment, should he or she become unable to make or communicate such choices.
B) an amendment to a will.
C) a situation of dying without having made a will.
D) the process by which an estate is settled and distributed in advance of the death.

Question 35

What type of will is made orally?

A) Conditional will
B) Holographic will
C) Nuncupative will
D) Verbal will

Question 36

Which of the following statements presents a case against euthanasia using the "wedge" or "slippery slope" argument?

A) "Euthanasia may or may not be moral, but by permitting it we may unwittingly pave the way for acts that are clearly immoral."
B) "Euthanasia is contrary to the Hippocratic Oath, which pledges physicians to sustain life not take it."
C) "Euthanasia may or may not be ethical, but by permitting it we may unwittingly create a burden on the judiciary when such decisions enter the legal arena."
D) "Euthanasia is contrary to good ethical judgment because medical science is not infallible and a mistaken diagnosis could cause a needless death."

Question 37

The living will is a

A) type of conditional will.
B) donation of gifts from an estate before the benefactor is deceased.
C) type of advance directive.
D) naming of an estate trustee in case of death.

Question 38

Which of the following is a statement by a competent person about choices for medical treatment, should he or she become unable to make such decisions or communicate them in the future?

A) Holographic will
B) Advance directive
C) Natural death act
D) Beneficent consent

Question 39

The Patient Self-Determination Act requires providers of services under Medicare and Medicaid to do which of the following?

A) Inform patients of their rights to appoint a health care proxy and draw up written instructions regarding treatment.
B) Refuse admission to patients who fail to sign an advance directive.
C) Document the patient's Five Wishes.
D) Determine patient's length of stay.

Question 40

Which state was the first to give legal recognition to the living will?

A) California
B) Florida
C) New Jersey
D) New Mexico

Question 41

In the United States, the first insurance company was established

A) by the Presbyterian Synod for its ministers.
B) by the Catholic Archdiocese for its nuns and priests.
C) by the City of New York for its firefighters.
D) by the federal government for its soldiers.

Question 42

The potential benefits of life insurance include all of the following EXCEPT it

A) usually makes funds available immediately after death.
B) increases social security benefits.
C) may reduce stress.
D) may provide relief and a sense of security to the bereaved spouse and other dependents.

Question 43

If a person dies without leaving a valid will, his or her property will be distributed according to

A) familial wishes.
B) federal rules.
C) state rules.
D) whatever the spouse requests.

Question 44

What type of settlement allows a person with terminal illness to sell his or her life insurance policy before death and receive a percentage of its face value?

A) volume
B) viatical
C) compensatory
D) percentage

Question 45

The right to refuse treatment remains constitutionally protected even when a patient is unable to communicate.

Question 46

Some people view removal of artificial nutrition and hydration as intentional killing.

Question 47

Physicians in the 1960s tended to withhold information regarding a life threatening condition.

Question 48

How can a will be amended?

A) It cannot be amended after it is signed.
B) It must be completely replaced if a change is requested.
C) By executing a codicil.
D) By the executor during the reading of the will.

Question 49

There is no medical or ethical distinction between withholding and withdrawing treatment.

Question 50

Most Americans lack living wills.

Question 51

When was the first life insurance company established in the United States?

A) 1759
B) 1859
C) 1863
D) 1763

Question 52

The health care proxy must be an attorney not a relative to carry out your wishes.

Question 53

Personal autonomy is restricted when passengers on an airline are required to wear seat belts.

Question 54

According to the laws of intestate succession, when no surviving heirs can be found, then proceeds from the estate go to

A) charity.
B) the state.
C) the IRS.
D) the executor.

Question 55

In the case involving Nancy Beth Cruzan in 1990, the Missouri Supreme Court ultimately ruled that her parents could have her feeding tube removed.

Question 56

The New Jersey Supreme Court allowed Karen Ann Quinlan's parents to discontinue her artificial respiration.

Question 57

Living wills contain physician orders and must be followed by emergency medical technicians.

Question 58

In attempting to settle an estate, the court will make a determined effort to locate heirs. If none can be found the proceeds go to the

A) United Way.
B) local non-profit family bereavement care center.
C) state.
D) federal government.

Question 59

Passive euthanasia is the bringing about of death through the administration of lethal injection.

Question 60

By the end of the twentieth century, less than half of the U.S. had passed some form of living will legislation.

Question 61

State laws specify a minimum age of 21 to make a legal will.

Question 62

Ethical wills are a twentieth century, new means to pass on wisdom, love, and personal values.

Question 63

Statistics show that most people die without leaving a will.

Question 64

Paramedics and EMT's are legally required to initiate CPR unless there is clear evidence of a valid DNR order.

Question 65

End-of-life issues and decisions are a private matter bearing directly on families and do not affect the realm of public policy.

Question 66

Financial advisors do not recommend the "family love letter" as it often contains emotional information and confuses EOL issues and personal desires after death.

Question 67

Do-not-resuscitate orders are a type of advance directive.