Ethical Decision-Making in Palliative Care
Dying and death occur in a context of personal beliefs and values about suffering, the meaning of death and the individual’s place within family and society. Palliative care is an approach that improves the quality of life of people, and their families, facing life-threatening illness.
Significantly when considering decision-making, the philosophy and policy underpinning palliative care elevates as its core principles, the idea that individuals, their families and caregivers are actively involved in the guidance of care. However, clinical experience, common sense and having good intentions do not always guarantee that health professionals will respond appropriately. The process of dying can create tensions and ethical dilemmas which elicit emotions and fierce personal opinions. Matters such as physician-assisted suicide, terminal sedation and the use of advance directives can give rise to difficult situations requiring robust questioning and consideration for clinicians.
Patient access to information, expanding clinical options and greater accommodation of the individuals’ person values in their care makes clinical decision-making increasingly complex. Discussions about care are not value neutral. There are likely to be effects, both beneficial and potentially harmful, when decisions are made. Dying people, their families and clinicians can play different roles in this process. Thus, caring for dying people requires a sensitive appreciation of the ethical, legal and moral perspectives of the person, their family and the clinical team. This requires an understanding of the context of suffering within which palliative care is often provided.
This chapter discusses the issues and practicalities involved in ethical decision-making in palliative care. It introduces an approach to ethical decision-making using clinical pragmatism as a framework for end-of-life care.
- A discussion on the ethical context of dying
- A description of the four-stage process of clinical pragmatism
- Consideration of conflicting opinions and advance directives
- Practical case study
- An extensive reference list (including books, journals and websites) for further reading and investigation