Ethical Dilemmas In End Of Life Care

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Myths have developed surrounding the law and ethical principles in end of life care, which can make care provision at the end of life complex and fraught with potential dilemmas. This article examines three of the most common myths related to the provision of palliative care and highlights their inadequacy when set against the ethical and legal principles on which end of life care pathways are based. the following end of life decisions (Quill et al 1997, Taylor 2003, Veterans’ Health Association National Ethics Committee 2007): Withdrawing or withholding life-prolonging treatment. For example, the care team might decide not to start a patient on ventilation, dialysis, artificial nutrition or hydration, or antibiotics. Alternatively, having…show more content…
Decisions to withhold or withdraw particular interventions are driven by the principles of best interest and consent (British Medical Association (BMA) 2007). Any decisions, either to withhold or withdraw life-prolonging treatment, will be acceptable insofar as they are in line with these principles. The end of life care pathway is a pathway, not a slide. Patients might travel up and down the pathway. Their condition might take an unexpected turn; or they might change their mind about a treatment; or a treatment might have disappointing effects. In these and similar cases, withdrawal of a treatment after trying it will be acceptable legally and ethically. If the team believes that a treatment could do some good, it would be unacceptable not to commence it on the basis of a false fear that it would not be possible to stop the treatment. Special legal procedures are associated with decisions relating to patients in a persistent vegetative state (BMA 2007). Intention Charges of murder and voluntary manslaughter require an intention to kill or harm on the part of the accused. It could be argued that a nurse has such an intention if he or she is responsible for certain actions, for example switching off a ventilator, or omissions, such as not attempting to resuscitate a patient. One way the law is sometimes said to address this problem is by invoking the doctrine of double effect (Cavanaugh 2006). The idea behind this doctrine is that some decisions made have both good…show more content…
Some of the criticism is part of a larger body of criticism of pathways and guidelines in general. Some critics believe that pathways undermine individualised care and remove the ability of clinicians to make small changes in patient care (Palmer 2008, Rycroft-Malone et al 2008). For more information on this debate, refer to the discussion in Kennedy et al (2009). Some of the criticism of end of life care pathways relates to law and ethics. In particular, critics state that diagnosing death and putting people on end of life care pathways is a form of euthanasia – one newspaper story featured the headline ‘Sentenced to death on the NHS’ (Devlin 2009). This type of criticism is founded on the myths outlined above, particularly those relating to passive and active euthanasia and to withdrawal of treatment. It is worth restating that care pathways allow healthcare professionals to try out treatments and withdraw them if they are not effective, and to reintroduce treatments if patients respond in unexpected ways. A clearer understanding of the ethics and law in this area should help nurses to address these criticisms and reassure themselves that the guidance set out in care pathways is legally and ethically sound. NURSING
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