ethics of end-of-life care and tissue donation

Basic ethical principles and end-of-life care

Principles of autonomy and best interests apply
A mentally competent patient can refuse any treatment or investigation, make an advanced refusal of treatment (ART) or appoint a proxy decision maker

Check if there is a legal proxy to make decisions and check if the patient made legally binding advanced decision/directive
Adult with Incapacity Act (2000)
- No intervention unless benefit to the adult couldn't be reasonably achieved without the intervention
- Least restrictive option
- Take account of persons past and present wishes and consult with those close to the patient - try to find out what the patient would have wanted if they were able to tell you

Refusal of treatment includes withholding and withdrawing treatment (including refusing artificial feeding or mechanical respirator)
ART must be valid and applicable to the treatment in question
- Must state the decision applies even if life is at risk
- Must be in writing, signed and witnessed

'Decisions concerning potentially life-prolonging treatment must NOT be motivated by a desire to bring about the patients death'
However, in some cases it is acceptable to:
- Withhold or withdraw life-prolonging/saving treatment
  - Acceptable if competent patient requested it, if it is best for the patient, or if the treatment is futile
- Give treatment that might cause patient's death
  - Only acceptable under the doctrine of double effect (DDE) - explains the permissibility of an action that causes a serious harm, such as the death of a human being, as a side effect of promoting some good end
  - Death is not the main cause, but secondary side-effect e.g. pain relief (e.g. morphine) in palliative care
  - Assisting suicide is illegal in the UK

The European Tissues and Cells Directive (2004)
Human Tissue (Scotland) Act (2006)
Only exception are reproductive cells - extra safeguards in the Human Fertilisation and Embryology Act (2008)