Match each clinical scenario involving end-of-life and palliative care to the core ethical concept or principle that best justifies the clinical decision.
- A physician administers a high dose of intravenous opioids to relieve severe, refractory dyspnea in a terminally ill patient, understanding that this intervention might secondarily suppress respiratory drive and hasten death.Principle of double effect
- A physician refuses to perform cardiopulmonary resuscitation on a patient with widespread metastatic disease and multi-organ failure, despite family demands, because the intervention cannot achieve its physiological goal.Medical futility
- A physician discloses a terminal lung cancer diagnosis directly to an elderly patient who has intact decision-making capacity, despite the adult children demanding the physician withhold the information to prevent distress.Respect for autonomy
- A hospital triage committee prioritizes intensive care unit beds for patients with reversible acute illnesses over those with irreversible, end-stage diseases during a severe resource shortage.Distributive justice
Answer
The correct pairings align specific end-of-life clinical actions with their foundational ethical principles: administering opioids for dyspnea despite risks aligns with the Principle of double effect; refusing non-beneficial CPR aligns with Medical futility; disclosing a diagnosis against family wishes aligns with Respect for autonomy; and allocating scarce ICU resources aligns with Distributive justice.
Each scenario accurately represents a core ethical framework used daily in palliative care. The principle of double effect protects physicians treating refractory symptoms at the end of life. Medical futility sets boundaries on non-beneficial aggressive care. Respect for autonomy centers the patient's right to information and self-determination. Distributive justice guides ethical rationing when resources are limited.
Step-by-Step Solution
Key Concept
Ethical Principles in Palliative and End-of-Life Care