Revision test for the Edexcel syllabus on Medical Ethics – End of Life Issues

THESE QUESTIONS ARE BASED ON THE COURSE NOTES FOR THE ABOVE TOPIC THAT CAN BE FOUND HERE, HERE and HERE.

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FOR THE ANSWERS TO THE QUESTIONS, SCROLL DOWN TO THE END OF THIS BLOG ENTRY.

  1. What is euthanasia?

a. Arranging for a person who is terminally ill to die without pain.

b. Using all medical means to keep a person from dying.

c. Using all medical means to help a person to die.

2. In which of the following countries is euthanasia in the form of doctor-assisted suicide still illegal?

a. Holland

b. France

c. Belgium

d. Switzerland

3. In the Netherlands, euthanasia is lawful. Which of the following is NOT one of the conditions that needs to be satisfied for doctor-assisted suicide to be legal in that country?

a. It must be carried out by a doctor.

b. The patient must have requested euthanasia in a manner which leaves no doubt that their decision is voluntary, well-informed and well-considered.

c. The patient must have a condition which causes them profound and prolonged mental and physical suffering that they find unbearable.

d. There must be no reasonable alternative (reasonable from the patient’s point of view) which might help to alleviate their suffering.

e. The doctor must have consulted another doctor who agrees with his or her judgement.

f. The decision of the two doctors must then be vetted by the Department of Health in the Netherlands.

4. The term ‘passive euthanasia’ is used …

a. To describe a situation where treatment is either withdrawn or not given to the patient in order to hasten death e.g. by turning off a life-support machine.

b. To describe the intentional, premature termination of another person’s life.

c. When someone’s life is ended by giving them an overdose of painkillers.

d. When someone’s life is ended prematurely at their request.

5. In 1 Corinthians 3 (in a passage often used by Christians in discussions about suicide and euthanasia), which sacred place does the early Christian convert St Paul compare the body to?

a. A Church

b. A synagogue

c. A temple

d. A sacred mountain

6. TRUE or FALSE? The influential Papal encyclical Humanae Vitae, written in the 1960’s states that ‘We are stewards, not owners, of the life God has entrusted to us. It is not ours to dispose of.’

7. TRUE or FALSE? The Catholic Church also believes that ordinary treatments (such as feeding a patient intravenously) may not be discontinued, but extra-ordinary measures (like complicated operations) need not be undertaken to save the patient’s life.

8. TRUE or FALSE? Hans Kung (an influential Catholic priest and author) argued that while God has given us free-will, we are not allowed to choose to end our own lives early when we are dying.

9. TRUE or FALSE? The Church of England disagrees with euthanasia but also teaches that it is not always right to strive to keep a patient alive for as long as possible regardless of their quality of life.

10. TRUE or FALSE? Joseph Fletcher supported the view that a person may have a right to die because, for a Christian, death is not the end, and ending a life of great pain might be the most loving thing to do.

11. TRUE or FALSE? According to Natural Moral Law theory as formulated by Thomas Aquinas to preserve life is a Primary Precept. So for those who follow this principle, it would seem that euthanasia is always wrong.

12. What is palliative care?

a. Allowing someone to die naturally.

b. Using medicine and other methods to keep severe pain under control.

c. Allowing people to die with dignity.

d. A form of oral medication.

e. Caring for someone at home.

13. Which of the following is NOT true?

a. Cicely Saunders helped to establish the discipline and the culture of palliative care.

b. She introduced effective pain management and insisted that dying people needed dignity, compassion, and respect, as well as rigorous scientific methodology in the testing of treatments e.g. the use of morphine to relieve pain in cancer patients.

c. Saunders introduced the idea of “total pain,” which included the physical, emotional, social, and spiritual dimensions of distress. Her concept of palliative care aims to help patients and their relatives with all aspects of the dying process.

d. Her pioneering approach was put into practice at St. Francis’s Hospice in Bristol which she helped to open in 1987.

14. TRUE or FALSE? There are about 500 hospices in England and many of them have a Christian basis as Christians believe they are an alternative to euthanasia.

15. Which of the following is NOT one of the aims of palliative care as practised within the modern Hospice Movement?

a. To relieve pain. Today it is thought it is not necessary for terminally ill patients to die in pain. Hospices specialize in pain control. Hospice staff believe all pain, however severe can be brought under control.

b. To try to persuade patients to become Christians by introducing them to Christian teachings about the afterlife.

c. To help patients, friends and relatives face up to death. Opportunities are given to the patients and to family members to discuss death and dying.

d. To care for the emotional needs of relatives – before, during and after the patient’s death.

16. Peter Singer has criticised the claim made by the Hospice Movement that all pain can be brought under control. Which of the following conditions is NOT cited by Singer as an example which shows that pain management cannot always be effective unless the patient is kept in a medically induced coma?

a. Motor Neurone disease.

b. Uncontrollable nausea and vomiting.

c. Bones that have become so brittle that they fracture at any sudden movement

d. Inability to control one’s bowels or bladder.

17. Which Christian denomination is opposed to euthanasia but emphasises that drugs which are intended to relieve pain but carry the risk of shortening life may be administered?

a. The Baptist Church

b. The Church of England

c. The Catholic Church

d. The United Reformed Church

18. TRUE or FALSE? Two UK based consultants who specialize in palliative care maintain that it should never be necessary for a doctor to treat their terminally ill patients with dangerous doses of opioids as severe pain can be adequately controlled without running this risk.

19. TRUE or FALSE? Jonathan Glover has argued that voluntary euthanasia may sometimes be morally acceptable in circumstances where a patient has made a carefully considered request for it but that the procedure itself should always be carried out by a qualified medical practitioner.

20. TRUE or FALSE? Glover has also suggested that in situations involving adults ‘whom we think may have lives worse than death but who are not in a position to express any decision of their own on this’ (e.g. because they are suffering from dementia) ‘the least unsatisfactory test is to ask what one would choose for oneself: would I choose death rather than have that sort of life?’

21. TRUE or FALSE? Some Christians think that withholding treatment (passive euthanasia) and letting nature take its course so that the patient eventually dies is morally acceptable, as no medical intervention takes place and so the doctors and medical staff would not be ‘playing God’.

22. TRUE or FALSE? Jonathan Glover has criticised this approach as he considers that is inhumane as a lingering, painful death may result from allowing nature to take its course. Active involuntary euthanasia might therefore relieve pain more quickly in cases where the patient has lost their sense of personhood, but perhaps not their capacity to experience pain.

23. TRUE or FALSE? Peter Singer argues that someone in an irretrievable coma has lost their sense of personhood, so it would not be morally wrong to switch off their life support machine.

24. Which of the following is NOT a valid concern about what might happen if euthanasia was legalised in the UK?

a. The sick and elderly may feel pressured to end their lives quickly, so as not to be a burden on their relatives who might be caring for them.

b. Someone who is ill, suffering pain, and very probably in a drugged and confused state of mind, may not be capable of making a rational decision about whether to live or die.

c. That in countries where euthanasia and/or doctor assisted suicide exists, opinion polls have indicated that many people worry about being euthanized against their will.

d. That if euthanasia is legalised there will eventually be a ‘slippery slope’ effect. This is because although such a law may only be intended to apply to cases of terminal illness and other conditions involving unbearable suffering, that because ‘unbearable suffering’ is hard to define (for example, drawing a clear line between suffering that is very bad and suffering that is intolerable with precision is very difficult), permission for euthanasia cannot be properly restricted and would inevitably become more permissive.

25. TRUE or FALSE? Dr Penney Lewis has argued that there is no evidence that non-voluntary euthanasia has increased because of the legalisation of voluntary euthanasia in Holland. In other words, there is no evidence for a ‘slippery slope effect’ in that country. Dr Lewis has also found no evidence for this in Oregon and Belgium too.

26. TRUE or FALSE? Some of those who are opposed to the legalisation of euthanasia in the UK and support the ‘slippery slope’ perspective have drawn attention to the fact that since the Abortion Act was introduced here that the sheer number of abortions performed annually suggest that what has resulted is effectively abortion on demand. They fear a similar outcome if voluntary euthanasia was introduced in this country.

27. TRUE or FALSE? The philosopher Ronald Dworkin has raised concerns about a real life case involving a patient called Margo, who was described by a medical student as being one of the happiest patients he had ever met, in spite of the fact that she was suffering from Alzheimer’s.

28. TRUE or FALSE? Dworkin raises the issue of whether, if Margo had signed an advance directive stating that she should not receive treatment for any serious, life-threatening disease that she might contract after Alzheimer’s had rendered her demented, that directive should be honoured, given that she is not actually suffering?

29. TRUE or FALSE? Dworkin argues that any advance decision a patient like Margo had made should not be honoured on utilitarian grounds, as Margo is happy, so as long as her surviving relatives and those treating her are also in agreement that Margo is still capable of taking pleasure in her life, the advance decision should be set aside.

30. A Swiss organisation which allows those who visit to legally opt for assisted suicide provided that they are of sound judgement and submit to an in-depth medical report prepared by a psychiatrist that establishes the patient’s condition as fulfilling the specifications of the Federal Court in the country is:

a. MDMD (‘My Death, My Decision’)

b. Gravitas

c. Dignitas

d. E.X.I.T

ANSWERS

  1. a
  2. b – but see HERE. France’s parliament has approved a bill that will let doctors keep terminally ill patients sedated until death – but stops short of legalising euthanasia or assisted suicide.
  3. f – NOTE: this question is designed to show how the process works in a country where euthanasia is legal.
  4. a – although turning off a life-support machine may be seen as an active measure to end someone’s life, it is nevertheless regarded as a form of passive euthanasia because it entails the withdrawing of further medical treatment.
  5. c – actually the Temple in Jerusalem.
  6. False – Humanae Vitae emphasised that human life is sacred. The quotation in the question is taken from the Catechism of the Catholic faith.
  7. True – note that Peter Singer regards continuing to feed a patient intravenously as an extraordinary measure, as most of us lack the medical training required to administer this treatment.
  8. False – Even though he is a Catholic priest, Kung argued that dying people should be allowed to use the free-will God has given them to make the choice whether to carry on living or not.
  9. True
  10. True
  11. False – Aquinas was also responsible for formulating the principle of double-effect, which has influenced Catholic thinking about abortion. Catholics do believe in the preservation of life but not in all circumstances without exception.
  12. b
  13. d – she was behind the opening of St Christopher’s Hospice in London in 1967.  St Christopher’s would be the first research and teaching hospice linking expert pain and symptom control, compassionate care, teaching and clinical research, pioneering the field of palliative care.
  14. False – as of 2008 there were over 150 adult independent hospices in England including 7 operated by Marie Curie Cancer Care and 6 by Sue Ryder Care.
  15. b – not everyone who works in a hospice is a Christian.  They do not try to make anyone believe in God, but provide opportunities to talk to ministers / priests if the patient wants. 
  16. a
  17. c
  18. True – so in effect, there should never have to be recourse to the doctrine of double-effect when it comes to doctor-assisted suicide/euthanasia.
  19. False – although Glover recognises that doctors will inevitably play their part, he thinks it preferable that wherever possible patients should self-administer the life ending medication in order to preserve the principle of autonomy in such matters.
  20. True – note that Ronald Dworkin thinks that where a patient is unable to communicate their wishes, and in the absence of an Advanced Directive or DNR (Do Not Resuscitate) notice, that doctors should consult with friends and relatives in order to ascertain whether that patient would wish to carry on living or be euthanized in such circumstances.
  21. True
  22. False – Peter Singer is the source of this criticism.
  23. True
  24. c – according to Peter Singer, in Holland a nationwide government commissioned study found that ‘many patients wanted an assurance that their doctor would assist them to die should their suffering become unbearable.’ Often, having received this assurance, no request for euthanasia was then made. The mere availability of euthanasia brought sufficient comfort in itself without it then having to be provided.
  25. True – However, the Belgium documentary ‘End Credits’ (see the course notes) features the case of ‘Eva’, who was euthanized purely on the basis of suffering from chronic mental illness. This case may concern those who believe that euthanasia should only be made available to those who are experiencing intolerable physical suffering.
  26. True – but Mary Warnock argues against the analogy with abortion. As she puts it, ‘…this analogy is by no means exact, if only because before 1967 abortion was already widely and increasingly carried out by ‘back street’ practitioners, who caused many deaths. Indeed, part of the purpose of the new law was to bring this to an end by ensuring that abortions were performed only competently, and by those licensed to do so. There is a difference between attempting to control by regulation a practice that is widespread, increasingly in demand and dangerous, and attempting to permit a practice that that will arguably never be widely in demand. We hold that the case against euthanasia must be defended separately, and not built on a doubtful analogy.
  27. True
  28. True
  29. False – an act utilitarian might arrive at this decision. However, Dworkin controversially argues that the decision made when Margo was mentally competent should still be honoured by those who are responsible for caring for her, even though in her presently demented state, she seems to be capable of enjoying life, and might continue to do so if she was treated for any serious illness she might develop.
  30. c- The organisation in question has been criticised for helping people to die who were not terminally ill and for promoting ‘suicide tourism’.