Deck 16: End-Of-Life Issues

Question 1

Which of the following statements is true?

A) old age is equal to dying
B) old age is a time of continued living
C) there is usually a short trajectory of dying before one is dead
D) death is simply biological
E) the juncture between living with a chronic illness and dying is relatively clear-cut

Answer 1

B

Question 2

Death at the beginning of the 21^st century differs from death occurring in early history in that

A) most will die suffering from chronic illnesses and organ system failures
B) most individuals do not live until old age
C) there is not a long trajectory of dying before one is dead
D) there is a clear juncture between living with chronic illness and dying
E) most individuals will die from infectious diseases

Answer 2

A

Question 3

Canadian data suggest that more older people who live in the community rather than a long-term care facility die

A) at home
B) at a family member's home
C) in hospital
D) in a long-term care facility
E) in ambulance

Answer 3

C

Question 4

Canadian data suggest that more older people who live in a long-term care facility rather than in the community die

A) at home
B) at a family member's home
C) in hospital
D) in a long-term care facility
E) in ambulance

Question 5

All but which of the following are true about suicide in old age?

A) suicide rates decrease near the end of life
B) little is known about the role of anxiety and fears, or threats of losing one's identity, as reasons for suicide in later life
C) older men are more likely to commit suicide than are older women
D) suicide tends to occur among older adults who have severe health problems
E) suicide tends to occur among older adults who have not attempted suicide before

Question 6

Five stages inherent within the process of dying have been proposed, which include all but

A) denial
B) anger
C) bargaining
D) acceptance
E) relief

Question 7

Dying individuals can have "crises of meaning," where they experience lack of meaning, coherence or comfort with their life. This has also been referred to as

A) spirituality
B) soul death
C) soul pain
D) fear of death
E) valuation of life

Question 8

The duration of life in various compromised health conditions refers to

A) crises of meaning
B) soul pain
C) valuation of life
D) quality-adjusted life years (QALYs)
E) good death

Question 9

The "gamble technique" is a method of computing

A) quality-adjusted life years (QALYs)
B) crises of meaning
C) valuation of life
D) soul pain
E) good death

Question 10

It has been argued that years of desired life is not determined entirely by quality of life, but is mediated by an intervening cognitive schema referred to as the valuation of life (VOL). All but which of the following statements is true about VOL?

A) it is the extent to which the person is attached to his or her present life
B) it predicts years desired to live
C) it is an attitude that motivates people for continuing to live longer
D) it is considered an existential concept, capturing the total reason for living
E) it is another measure of psychological well-being

Question 11

Which of the following would be less likely to be associated with fear of death?

A) being younger
B) being of higher socio-economic status
C) being female
D) being white rather than black
E) being less religious

Question 12

In a Canadian study, five domains of quality-of-life care were identified, which include all but which of the following?

A) receiving adequate pain and symptom management
B) taking the necessary measures to prolong life under all circumstances
C) achieving a sense of control
D) relieving burden
E) strengthening relationships with loved ones

Question 13

Which of the following is an example of a health status trajectory?

A) good psychological health
B) strong sense of self
C) control of your dying process
D) loved ones close by
E) sudden death from an unexpected cause

Question 14

Which of the following characterizes quality of life at the end of life?

A) it focuses on life not death
B) it is not concerned beyond the physiological aspects of dying
C) it focuses on pain associated with death
D) it focuses on the suffering associated with death
E) it focuses on health-status trajectories

Question 15

When examining quality of life near the end,

A) people tend to become more religious than previously
B) those who are not religious are less likely to be depressed
C) one can have poor physical health but high overall quality of life, even in the face of death
D) one with poor physical health cannot have a high overall quality of life in the face of death
E) good psychological health would be an example of a health-status trajectory

Question 16

At the end of life, older adults place a high value on all but which of the following?

A) candid and sensitive communication
B) respect and recognition
C) a multi-disciplinary approach
D) comfort
E) a medical approach

Question 17

Older adults tend to place a high value on comfort at the end of life. All but which of the following statements is true about comfort?

A) it is subjective, only the individual knows whether s/he is comfortable
B) it focuses on the provider of the care
C) it includes physical comfort, which is only one part of overall comfort
D) it includes both spiritual and psychological well-being
E) it includes state of ease and contentment, relief from discomfort, and being strengthened and invigorated

Question 18

Research suggests that health care providers, particularly physicians, often make decisions about care for the dying

A) that are consistent with the wishes of the older person
B) that are inconsistent with the wishes of the older person
C) that are inconsistent with the wishes of family members
D) by consulting other health professionals
E) by consulting their closest friends

Question 19

Chronic illnesses evolve in a gradual fashion. Determining when one is dying, therefore, is a(n)

A) clinical judgment
B) judgment made by the patient
C) judgment made by the patient's family
D) judgment made by the courts
E) impossibility

Question 20

There has often been a lack of communication between the physician and the older person at the end of life. All but which of the following make this communication challenging?

A) the difficulty of definitive diagnoses and prognosis
B) a desire to maintain the hopes of the older person
C) professional discomfort in discussing death
D) maintaining a balance between honesty and compassion
E) the older person and the family does not usually want to hear the truth

Question 21

Which of the following cultural groups would be more likely to hold a family-centred model of medical decision making, rather than one that favours patient autonomy?

A) First Nations
B) Dutch
C) African
D) European
E) Korean

Question 22

The first palliative care program in Canada was established in 1974 in which city?

A) Halifax
B) Montreal
C) Toronto
D) Winnipeg
E) Calgary

Question 23

In Canadian usage of terms related to palliative care,

A) palliative care and hospice are used synonymously
B) hospice represents a formal set of practices
C) palliative care is used as a more general descriptive term
D) hospice is used as a more general descriptive term
E) palliative care is closely linked to federal requirements for medicare funding

Question 24

All but which of the following statements is true about palliative care in Canada?

A) Many are advocating for an expansion of palliative are because acute care and medical care are not adequately meeting the needs of dying individuals.
B) It is also called hospice care.
C) The first palliative are program was established in Montreal.
D) Provincial palliative care associations do not exist in all provinces.
E) Hospice care has arisen as an alternative to institutional care.

Question 25

The focus in palliative care is on

A) maximum survival
B) maximum comfort
C) maintaining life at all costs
D) aggressive medical care
E) the physiological aspects of dying

Question 26

Which of the following would be consistent with a palliative care approach?

A) aggressive diagnostic tests
B) treatment of coexisting medical conditions
C) transfer to acute care hospitals
D) tube feeding if eating is not possible
E) no cardiopulmonary resuscitation

Question 27

Which of the following statements is true about hospice care?

A) there is a distinction between palliative care and hospice care in Canada
B) there are difficulties with pain management in palliative care, with many people still reporting substantial pain
C) it advocates for transfer to acute care for technological interventions
D) it focuses on the physiological aspects of dying
E) it focuses on aggressive medical care

Question 28

It has been estimated that between 10 and 50 percent of patients receiving palliative care

A) still report substantial pain
B) do not report any pain
C) report very little pain
D) report being satisfied with their pain management
E) report being very satisfied with their pain management

Question 29

All but which of the following are difficulties that may occur with pain management in palliative care?

A) some still report significant pain
B) increased dosages can lead to decreased cognitive functioning
C) increased dosages can lead to unconsciousness
D) increased dosages can lead to terminal sedation
E) most people are able to convey their symptom status and pain level, days before death

Question 30

Which of the following statements is true about non-life-sustaining measures, euthanasia, and assisted suicide?

A) heroic life-sustaining measures that prolong the dying process are generally seen as necessary and acceptable
B) there is less consensus on the practice of active euthanasia
C) there is more consensus on the practice of assisted suicide
D) aggressive medical care improves life expectancy among those who are dying
E) aggressive medical care improves quality of life among those who are dying

Question 31

Withholding or withdrawing artificial life support or medical treatment and allowing a patient to die refers to

A) involuntary euthanasia
B) non-voluntary euthanasia
C) passive euthanasia
D) active voluntary euthanasia
E) physician-assisted euthanasia

Question 32

Which of the following refers to active voluntary euthanasia?

A) withholding or withdrawing artificial life support or medical treatment and allowing the patient to die
B) the physician administers a lethal dose of medication to a competent person who requests it
C) becoming a volunteer to assist patients in ending their own lives
D) ending the life of a mentally incompetent person who is unaware of what is happening and is not able to request it
E) ending the life of a mentally competent person who does not request it

Question 33

Which of the following statements refers to involuntary euthanasia?

A) withholding or withdrawing artificial life support or medical treatment and allowing the patient to die
B) the physician administers a lethal dose of medication to a competent person who requests it
C) becoming a volunteer to assist patients in ending their own lives
D) ending the life of a mentally incompetent person who is unaware of what is happening and is not able to request it
E) ending the life of a mentally competent person who does not request it

Question 34

Which of the following groups would be least likely to believe that those in pain and with a terminal illness should have access to assistance with dying?

A) Chinese Americans
B) Filipino Americans
C) Hawaiians
D) Japanese Americans
E) Caucasian Americans

Question 35

Who can rule whether or not an individual is competent to make his or her own decisions?

A) only physicians
B) only family members
C) only courts
D) physicians and family members
E) courts and physicians

Question 36

Advanced directives are for an individual to leave in case they become unable to make their own decisions. Which of the following are examples of advanced directives?

A) a substituted judgment standard and a best interests standard
B) a durable power of attorney for health care and a best interests standard
C) a living will and a durable power of attorney for health care
D) a living will and a substituted judgment standard
E) a living will and a best interests standard

Question 37

Which of the following statements defines a living will?

A) a document in which the individual expresses his or her treatment preferences in specific situations
B) a document in which an individual appoints a proxy decision-maker who will make their treatment decisions on their behalf when they are unable to do so
C) a document in which another individual makes the decision that they believe the individual would make if he or she was still capable
D) a document in which a surrogate decides on the basis of the well-being of the individual
E) a document that indicates who will receive the individual's belongings when death occurs

Question 38

Which of the following statements defines a durable power of attorney for health care?

A) a document in which the individual expresses his or her treatment preferences in specific situations
B) a document in which an individual appoints a proxy decision-maker who will make their treatment decisions on their behalf when they are unable to do so
C) a document in which another individual makes the decision that they believe the individual would make if he or she was still capable
D) a document in which a surrogate decides on the basis of the well-being of the individual
E) a document that indicates who will receive the individual's belongings when death occurs

Question 39

A woman is considered incompetent and she has not left an advanced directive. Her son is called upon as a surrogate to make a decision he believes his mother would make if she were still capable. This is an example of

A) a living will
B) the substituted judgment standard
C) the best interests standard
D) a good death
E) the surrogate judgment standard

Question 40

Which of the following is true about euthanasia at the present time?

A) attitudes toward physician-assisted suicide and euthanasia are becoming less acceptable
B) a small but significant proportion of older adults would choose this course if their quality of life was low enough
C) physicians do not prefer assisted suicide to euthanasia
D) more physicians than older adults favor aid in dying
E) there is a preference of suicide over euthanasia

Question 41

Which of the following is true about end-of-life issues?

A) most older people die alone
B) palliative care embraces only the dying individual
C) focus tends to be on the dying individual
D) there is always consensus about decisions between family members and the dying individual
E) research suggests that family members are more satisfied with end-of-life care loved one's receive in a nursing home compared to hospice

Question 42

Which of the following statements about friends of the dying individual is true?

A) friends are often excluded by professionals and family members
B) friends are welcomed by professionals and family members
C) friendship ties at the end of life are stronger than family ties
D) dying individuals have expressed a strong preference to be with friends at the end of life
E) institutions often have a policy that allows non-kin to visit those who are dying

Question 43

For a growing number of people, end of life comes in

A) a hospital
B) a hospice
C) a nursing home
D) one's own home
E) the home of a family member

Question 44

The interval between knowledge of impending death and death itself, is said to characterize the nursing home environment and its exclusion from mainstream society. This interval is called

A) the waiting interval
B) the living-dying interval
C) the health status interval
D) the quality of life interval
E) the quantity of life interval

Question 45

A funeral is an example of

A) a trajectory
B) a crisis of meaning
C) a good death
D) a death ritual
E) euthanasia

Question 46

Which of the following is true in Canada when people die?

A) few are buried in the earth
B) most are buried in the earth
C) many are cremated, but this trend is decreasing
D) entombment is very common
E) entombment never occurs

Question 47

According to the National Advisory Committee's Guide to End-of-Life Care for Seniors, funerals serve all but which of the following purposes?

A) provide a legitimate public occasion for expressing grief
B) provide social support for the survivors
C) help occupy the bereave person's time in a difficult situation
D) reaffirm social order
E) decrease the reality of death

Question 48

Which of the following statements is true about funerals?

A) funeral homes are in the business of imaging death
B) there is a decrease in arranging one's own funeral
C) embalming and park-like cemeteries help reduce denial of death
D) funeral traditions are relatively constant among cultural groups
E) cremation tends to be more expensive than burial

Question 49

The Canadian Palliative Care Association has identified as priority issues all but which of the following?

A) access to end-of-life care
B) professional education
C) creation of more hospices
D) research and data collection
E) public education and awareness

Question 50

While death is defined in biological terms, it is also social, emotional, and spiritual.

Question 51

Because a person is older, s/he is necessarily completely prepared for death.

Question 52

Given that death occurs primarily in old age from chronic illnesses, there is a clear dividing line between someone who is ill and someone who is dying.

Question 53

First Nations culture has values prohibiting direct communication between physician and patient of prognosis or palliative care options.

Question 54

Death rituals are rights of passage that provide formal recognition of the transition from life to death.

Question 55

What does "valuation of life" mean?

Question 56

Describe and contrast health-status trajectories and quality-of-life trajectories.

Question 57

What does "comfort" mean in relation to dying? What aspects of comfort have been examined?

Question 58

Discuss the role of the physician at the end of life.

Question 59

How do the terms palliative care and hospice differ between Canada and the United States? What Canadian organizations exist in palliative care?

Question 60

Discuss some of the criticisms of hospice care.

Question 61

Describe the different types of euthanasia.

Question 62

What are advanced directives? Identify and briefly discuss the important concepts related to advanced directives.

Question 63

Briefly discuss some of the trends being witnessed with respect to funerals.

Question 64

Discuss how the federal government is increasingly recognizing the importance of the end of life.

Question 65

Discuss the role of religion in dying. What evidence is there that religious beliefs become stronger near death?

Question 66

Discuss the importance of communication between the physician and the older person at the end of life. What makes communication challenging in this situation? What role does culture play?

Question 67

Discuss the issue of competence regarding end-of-life issues. What are the challenges in end-of-life decisions for people with dementia? Discuss how advance directives may or may not simplify this issue.

Question 68

Discuss common issues involved with family and friends at end of life.

Question 69

Discuss dying within a nursing home setting. How does dying in a nursing home differ from dying at home? What is the relationship of nursing homes to hospice care?