Ethical issues in palliative care

Advocacy at the End of Life: Meeting the Needs of Vulnerable Latino Patients

“…These circumstances can negatively affect dying patients' and their family caregivers' discharge plans, thereby influencing patients to make quick decisions without understanding all the facts (Bauer, Fitzgerald, Haesler, & Manfrin, 2009). The findings emphasize that good communication in patient-provider discussions is needed in order to discuss sensitive topics about dying, to document advance directives, and to arrange for hospice care in the home (Kinlaw, 2005) or in a long-term care setting such as nursing home (Kelly & Penney, 2011) before problems can occur. Providers indicated the need to understand that discharge planning and EOL decision making are time-consuming and that this process is especially difficult for Latino patients who may have had negative experiences with health care providers (Carrion, 2010b).…”

Understanding Goals of Care Statements and Preferences Among Patients and Their Surrogates in the Medical ICU

“…Communication must be open and honest to ensure patients and families have optimal participation in decision-making. 2 However, communication in an ICU setting is challenging due to barriers such as the highly charged emotional environment wherein patients and family members may be anxious or depressed and the clinical context in which the care team may not have a prior relationship with the patient. 3 …”

Are Physicians Ethically Obligated to Address Hospice as an Alternative to “Usual” Treatment of Advancing End-Stage Disease?

“…4 The key criteria for admission to hospice is the presence of a life-limiting disease that is believed to limit the patient's survival to six or fewer months and the patient's decision to forgo further aggressive interventions that aim for a cure or long-term remission. 7 It is to be noted that contrary to the belief of many health providers, a patient does not to have to consent to do not resuscitate (DNR) status in order to to receive home hospice care. The goal of hospice care is to maximize the relief of suffering and dysphoric symptoms and to foster as much as possible a sense of emotional, social, and spiritual well-being.…”

“…The doctor has forgotten that patient autonomy depends, for its proper function, on informed consent, and this lapse betrays a lack of respect for the autonomy of the patient, especially one who has specified end-of-life wishes in an advance directive. 7 Under the doctrine of informed consent, the physician has a duty to fully inform the patient about the likely consequences of any clinical decision that affects his health and well-being. In addition to describing the nature and hoped-for benefit of the next treatment and its risk, the doctor is supposed to tell the patient about the alternative to this treatment, 8 in this case, palliative and hospice care.…”