Chapter 06 - End-of-Life Issues and Decisions

Test Bank for Last Dance Encountering Death and Dying

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Chapter 06
End-of-Life Issues and Decisions

Multiple Choice Questions

1. (p. 214) 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.

2. (p. 214) 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

3. (p. 214-215) Three principles of medical ethics are

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

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Chapter 06 - End-of-Life Issues and Decisions

4. (p. 215) 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

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Chapter 06 - End-of-Life Issues and Decisions

5. (p. 215) What is a fundamental principle in medical care which is the injunction to "do no
harm?"
A. Nonmaleficence
B. Beneficence
C. Assistance
D. Etiologicality

6. (p. 215) 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.

7. (p. 216) What year did informed consent achieve formal legal definition?
A. 1929
B. 1945
C. 1957
D. 1963

8. (p. 216) 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.

9. (p. 216) A study in 1961 found that, __________ doctors had a strong tendency to withhold
information.
A. few
B. most
C. military
D. hospital-based

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Chapter 06 - End-of-Life Issues and Decisions

10. (p. 219) The SUPPORT STUDY was designed to

A. help families find an appropriate hospice program.
B. aid hospitals in developing end-of-life protocols.
C. unionize hospital personnel.
D. assess communication between physician and patient at the end-of-life.

11. (p. 219) 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.

12. (p. 222) 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.

13. (p. 222) 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."

14. (p. 222) 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.

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Chapter 06 - End-of-Life Issues and Decisions

15. (p. 222) 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.

16. (p. 223) 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

17. (p. 223) 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)

18. (p. 224) 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.

19. (p. 227) 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.

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Chapter 06 - End-of-Life Issues and Decisions

20. (p. 227) Currently, physician-assisted death is permitted by legislation enacted in

A. California and Ohio.
B. Nevada and Michigan.
C. Oregon and Washington.
D. New York and Pennsylvania.

21. (p. 227) In May 2013, which state senate passed and the governor signed the Patient Choice
and Control at End-of-Life Act?
A. North Carolina
B. New Mexico
C. Vermont
D. New Hampshire

22. (p. 227) Which act allows physicians to prescribe lethal medication to terminally ill
patients?
A. California Patient Compassion Act (CPCA)
B. Oregon Death with Dignity Act (ODDA)
C. United States Terminal Sedation Act (USTSA)
D. New York Samaritan Death Act (NYSDA)

23. (p. 228) Who provided aid-in-dying to more than 100 people and led a crusade to legalize
physician-assistant suicide?
A. Thomas Youk
B. Jack Kevorkian
C. John Pridonoff
D. Madeline Jacobs

24. (p. 229) 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

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Chapter 06 - End-of-Life Issues and Decisions

25. (p. 229) Euthanasia comes from the Greek

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

26. (p. 230) 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

27. (p. 230) 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."

28. (p. 234) 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

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Chapter 06 - End-of-Life Issues and Decisions

29. (p. 234) 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.

30. (p. 234) 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.

31. (p. 234) 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.

32. (p. 234) 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

33. (p. 234) Which state was the first to give legal recognition to the living will?
A. California
B. Florida
C. New Jersey
D. New Mexico

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Chapter 06 - End-of-Life Issues and Decisions

34. (p. 237) 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

35. (p. 237) 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

36. (p. 238) 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.

37. (p. 242) 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.

38. (p. 242) 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

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Chapter 06 - End-of-Life Issues and Decisions

39. (p. 243) What type of will is made orally?

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

40. (p. 243 and 247) A codicil relates to

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

41. (p. 243 and 248) What is the condition when a person dies without having left a valid will?
A. Intestate
B. Attestation
C. In holographic
D. Testator

42. (p. 245) 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.

43. (p. 246-247) 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.

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Chapter 06 - End-of-Life Issues and Decisions

44. (p. 248 and 251) 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.

45. (p. 248) 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.

46. (p. 251) 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.

47. (p. 253) 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.

48. (p. 253) 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.

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Chapter 06 - End-of-Life Issues and Decisions

49. (p. 253) When was the first life insurance company established in the United States?
A. 1759
B. 1859
C. 1863
D. 1763

50. (p. 254) 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

True / False Questions

51. (p. 214) Personal autonomy is restricted when passengers on an airline are required to wear
seat belts.
TRUE

52. (p. 216) Physicians in the 1960s tended to withhold information regarding a life threatening
condition.
TRUE

53. (p. 222) The New Jersey Supreme Court allowed Karen Ann Quinlan's parents to discontinue
her artificial respiration.
TRUE

54. (p. 222) In the case involving Nancy Beth Cruzan in 1990, the Missouri Supreme Court
ultimately ruled that her parents could have her feeding tube removed.
TRUE

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Chapter 06 - End-of-Life Issues and Decisions

55. (p. 225) The right to refuse treatment remains constitutionally protected even when a patient
is unable to communicate.
TRUE

56. (p. 225) Passive euthanasia is the bringing about of death through the administration of lethal
injection.
FALSE

57. (p. 225) There is no medical or ethical distinction between withholding and withdrawing
treatment.
TRUE

58. (p. 231) Some people view removal of artificial nutrition and hydration as intentional
killing.
TRUE

59. (p. 235) By the end of the twentieth century, less than half of the U.S. had passed some form
of living will legislation.
FALSE

60. (p. 235) Most Americans lack living wills.

TRUE

61. (p. 235) Living wills contain physician orders and must be followed by emergency medical
technicians.
FALSE

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Chapter 06 - End-of-Life Issues and Decisions

62. (p. 237) The health care proxy must be an attorney not a relative to carry out your wishes.
FALSE

63. (p. 240) Do-not-resuscitate orders are a type of advance directive.

TRUE

64. (p. 241) Paramedics and EMT's are legally required to initiate CPR unless there is clear
evidence of a valid DNR order.
TRUE

65. (p. 244) State laws specify a minimum age of 21 to make a legal will.
FALSE

66. (p. 244) Financial advisors do not recommend the "family love letter" as it often contains
emotional information and confuses EOL issues and personal desires after death.
FALSE

67. (p. 245) Ethical wills are a twentieth century, new means to pass on wisdom, love, and
personal values.
FALSE

68. (p. 250) Statistics show that most people die without leaving a will.
TRUE

69. (p. 256) End-of-life issues and decisions are a private matter bearing directly on families and
do not affect the realm of public policy.
FALSE

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