Cultural and Ethical Challenges in Providing Palliative Care for Cancer Patients at the End-of-Life

Abstract

End-of-life (EOL) care presents many challenges both for clinicians, as well as for patients and their families. Moreover, the care of the dying patient must be considered within the context of the psychological, physical, and social experiences of a person's life. Foremost among those who require EOL care are cancer patients at the EOL. Unfortunately, clinicians who are responsible for the treatment of patients at the EOL commonly lack adequate training to help guide EOL decisions and to deliver bad news to patients and families. They must also face their own discomfort with discussions about death and deal with poor compensation for the time spent discussing EOL care with patients and families. Given the unique process of each person's death, strategies are often inadequate to guide patients, their families, and the clinicians who care for them through this complex and emotionally challenging process. It would stand the clinician in good stead to be aware of these challenges and have an approach towards dealing with such problems. In addition, organizations have a responsibility to ensure that systems are in place to minimize its occurrence and ensure that staff are supported through the process of resolving issues and conflicts that may arise.

Ethical considerations at the end-of-life care

“…Hospice can be provided in any setting, including patients’ homes, nursing homes, hospitals, and a separate hospice facility. 55 , 56 In addition to patient care, the interdisciplinary team provides support to the primary caregiver or family member who is responsible for the majority of the patient care. 55 , 57 Hospice team may provide emotional and spiritual support, social services, nutrition counseling, and grief counseling for the patients and their families.…”

“…The application of the ethical principles in palliative decision-making is required to achieve a comfortable end-of-life period for patients. 53 , 56 …”

“…Nonmaleficence emphasizes on relieving the symptoms that can actually harm the patient. 56 In palliative care setting, the end-of-life decision mentioned above (CPR, MV, ANH, terminal sedation, withholding and withdrawing treatment) may need to be taken. The application of the ethical principles in palliative decisionmaking is required to achieve a comfortable end-of-life period for patients.…”