End of Life Issues in Cancer Care Are We Making Progress?. Carol Taylor, RN, PhD Georgetown University Center for Clinical Bioethics. Are We Making Progress?.
Carol Taylor, RN, PhD
Center for Clinical Bioethics
1. Continuing to participate in care for hopelessly ill person who is being sustained on a ventilator, when no one will make a decision to “pull the plug”
2. Following a family’s wishes to continue life support even though it is not in the best interest of the patient
3. Initiating extensive life-saving actions when I think it only prolongs death
4. as creating the highest degree of moral distress for critical care nursesFollowing the family’s wishes for the patient’s care when I do not agree with them but do so because the hospital administration fears a lawsuit
5. Carrying out the physician’s orders for unnecessary tests and treatments for terminally ill patients[Elpern, E.H., Covert, B. & Cleinpell, R. (November 2005). Moral distress of staff nurses in a medical intensive care unit. American Journal of Critical Care, 14(6), 523-530.]
Letting Go as creating the highest degree of moral distress for critical care nurses
What should medicine do when it can’t save your life?
The New Yorker, August 2, 2010
2. What does good care at the end-of-life “look like?” How can family and professional care givers respond to the holistic needs of dying persons? What does it mean to be a healing presence for the dying and their families?
pain and symptom management,
clear decision making, preparation for death, completion, contributing to others, and
affirmation of the whole person]
3. Do persons have the right to choose the time and manner of their dying? If you grant this right, are health care professionals and institutions obligated to meet all the requests patients make, so long as they are requests for legal interventions. Does the public (taxpayers) have an obligation to fund the services you desire?
4. Is reasonable to assume that once we grant the right to die this may evolve into a duty for some to die so that the resources they are consuming may be better allocated? Should government or some other body be granted the authority to determine who lives and who dies?
5. In what concrete ways do individual beliefs, values and faith commitments influence our response to the above questions?
At century’s turn: of their dying? If you grant this right, are health care professionals and institutions obligated to meet all the requests patients make, so long as they are requests for legal interventions. Does the public (taxpayers) have an obligation to fund the services you desire?
at home: a family, communal, religious (non-medical) event
of accidents, infectious disease
By the 1970s:
of heart disease, cancer, stroke
an institutional, professional, & technological process -- in hospitals, i.e., the medicalization of dyingThe broader context:trends in how & where we die, past & present
Continuum? Logical extension of respect for autonomy/right to privacy arguments?
Voluntary, informed refusal
Withholding & Withdrawing
Palliative & Hospice Care
Patient or surrogate demands for futile Rx
Continuum? Application of the clinician’s duty of compassion? Principles of “beneficence” or “non-maleficence”?
Are there limits to patient autonomy/privacy? Is there a point beyond which clinicians cannot or should not go?