Ethical issues in palliative care
- Erik K Fromme, MD
Erik K Fromme, MD
- Associate Professor of Medicine, Radiation Medicine, and Nursing
- Oregon Health & Science University
- Mary Denise Smith, RN, CNS
Mary Denise Smith, RN, CNS
- Instructor of Medicine and Nursing
- Oregon Health & Science University
- Section Editors
- Robert M Arnold, MD
Robert M Arnold, MD
- Editor-in-Chief — Palliative Care
- Section Editor — General Principles of Palliative Care
- Chief, Section of Palliative Care and Medical Ethics
- University of Pittsburgh School of Medicine
- Kenneth E Schmader, MD
Kenneth E Schmader, MD
- Editor in Chief — Geriatric Medicine
- Section Editor — Geriatrics
- Chief, Division of Geriatrics
- Duke University
- Director, Geriatric Research Education and Clinical Center
- Durham VA Medical Centers
Ethical issues in palliative care often arise because of concerns about how much and what kind of care make sense for someone with a limited life expectancy. There is often conflict between clinicians, nurses, other healthcare team members, patients, and family members about what constitutes appropriate care, particularly as patients approach death.
This topic will discuss ethical issues in palliative care. Other issues regarding the legal aspects of end of life care, advance care planning, how to approach requests for potentially inappropriate and futile therapies, and discussing goals of care are discussed separately. In addition, issues related to specific symptoms for the patient in palliative care and/or at the end of life are discussed separately.
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- FRAMEWORK FOR ETHICAL REASONING
- Applying principlism in palliative care
- - Palliative paternalism
- Alternative moral frameworks
- APPLYING ETHICS IN CLINICAL SETTINGS
- Decision making
- - Determining best interest
- - Working with surrogates
- - Impact of acting as a surrogate
- Conflicts of value
- SPECIFIC SCENARIOS
- Application of Do Not Resuscitate orders
- Advance care planning
- Withdrawing versus withholding treatment
- Time-limited trial
- Pain management at the end of life
- Requests from the family to withhold information
- Requests to discontinue life sustaining treatment
- Palliative sedation
- - Proportionate palliative sedation
- - Palliative sedation to unconsciousness
- Physician assisted death