Treatment Escalation Plans (TEPs) risk becoming the next ‘tick box exercise’, if not supported by open and compassionate conversations by healthcare teams brave enough to adequately address the culturally taboo subject of death. This requires a wider system of ongoing support, education and clinical leadership to create a culture of open communication. While excellent to read the emphasis that palliative treatments should not be reserved for the terminally ill, further advancements would see ‘Supportive Care’ move from the lowest levels of escalation to becoming embedded as standard practice for all deteriorating patients. This supportive element of care, underpinned by clear communication, could accompany patients regardless of their level of escalation. Through adopting the Palliative and Supportive Care ethos, addressing not only physical symptom needs, but also exploring social, psychological and spiritual concerns, be it in the ICU or on a general ward, we may move closer towards offering the truly individualised plans of care that TEPs promise.
Ethical decision-making in palliative care can present unique challenges to all doctors. When caring for palliative patients, GPs will often be faced with complex decisions and discussions on issues including cardiopulmonary resuscitation, capacity, the role of autonomy, truth-telling and hope, and end of life nutrition and hydration. This article aims to provide an overview of the relationship between ethics, the law and our professional responsibilities. It will describe how GPs can utilise the framework of principlism to make ethical decisions. It will also look at how GPs should assess capacity, and address some of the more common ethical dilemmas faced by GPs.
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