Chapter 5: Ethical Decision-making
Description:
Decision-making at the end of life necessarily occurs within an ethical framework. Dying and death occur in a context of personal values and beliefs about suffering, the meaning of death and the place of an individual within family and society. Questions can arise regarding such matters as the use of morphine, physician-assisted suicide and terminal sedation. Caring for these people requires a sensitive appreciation of the ethical, legal and moral perspectives of the patient, the family and the clinical team. This requires an understanding of the context of suffering within which palliative care is often provided.
Topics:
- Introduction
- The ethical context of suffering
- Clinical Pragmatism
- The use of sedation
- The ethical problem
- Case study
- Discussion of the case study
- Principles from the case study
- Thorough assessment of the clinical situation
- Findings of assessment discussed openly and frankly
- A clear goal identified
- A time period for review established
- Novice practitioners’ ongoing support and mentoring
- Sedation use in emergency situations predicted and planned
- The principle of ‘double effect’
- Requests to hasten death
- The ethical problem
- Case study
- Discussion of the case study
- Principles from the case study
- Symptom management
- Differing desires for end-of-life care
- The ethical problem
- Case study
- Discussion of the case study
- Principles from the case study
- Conclusion
Author / Speaker:
Dr Margaret O‘Connor
Margaret lectures in cancer and palliative care at La Trobe University, Melbourne (Victoria, Australia), within a unit that is dedicated to academic and clinical studies of cancer and palliative care, in association with a tertiary referral hospital. Margaret’s doctoral thesis in nursing explored discourses about care of the dying in residential aged care. Her ethical interests have evolved from the work of her first degree in theology. Margaret is board member of Eastern Palliative Care, a large domiciliary service in Melbourne, and she chairs the Clinical Standards Committee and the Ethics Committee of that organisation.
Sanchia Aranda
Sanchia is professor and director of cancer nursing research at Peter MacCallum Cancer Institute, Melbourne (Victoria, Australia). She has worked in cancer care since 1979, predominantly in the tertiary sector since 1990. Her research interests include cancer and palliative nursing in both inpatient and community settings, especially in the area of supportive care. Her research, both quantitative and qualitative, concentrates on implementing evidence into clinical practice, especially in improving the delivery of health services and the outcomes for people with cancer and their families. Current studies include workforce planning in breast care, the support needs of women with advanced cancer, symptom interventions in pain and fatigue, prevention of oral mucositis, and care of people suffering bodily decay.
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