Ethical issues in palliative care

• Autores: Victoria J. Wheatley, Jenna C. Smith, Ilora G. Finlay
• Localización: Medicine, ISSN-e 1357-3039, Vol. 43, Nº. 12, 2016, págs. 742-744
• Idioma: inglés
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• Resumen

  • Even in those with advanced, life-threatening disease, the prognosis is uncertain, and patients and relatives can derive benefit from involvement in planning care. Many patients undertake informal care planning in collaboration with healthcare professionals, but only a minority proceed to formal advance care planning. Better care planning is needed for frail patients with failing decision-making capacity, for whom emergency admission and terminal care in hospital would be inappropriate. Communication with the patient and family should guide clinicians about the goals of treatment. The multiprofessional team must then consider the likely benefits of interventions and recognize when these have become (or would be) burdensome and ineffective in the face of irreversible deterioration. Patients and relatives should be kept informed about treatment options. Patients who lack capacity to make decisions about their place of care, and who do not assent to care as an inpatient, may experience deprivation of liberty. Relatives may also be concerned when inpatient care is arranged. Independent assessment must ascertain whether the arrangements in place are in the patient's best interests. Those dying while subject to a Deprivation of Liberty order may have ‘died in state detention’; all such cases should be discussed with the coroner.