What are the ethics of end-of-life care?
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The Ethics of End-of-Life Care
Ethical Advocacy in End-of-Life Nursing Care
Ethical advocacy is a crucial component of end-of-life nursing care. Nurses play a vital role in ensuring that patients receive quality and competent care by adhering to ethical principles, championing social justice, and safeguarding patients' rights. This involves applying collective wisdom and involving hospital ethics committees when necessary. Ethical advocacy requires organizational and personal power, as well as ethical leadership, to achieve optimal ethical governance in healthcare settings1.
Ethical Challenges in End-of-Life Care for Cancer Patients
End-of-life care for critically ill cancer patients presents significant ethical challenges. Oncologists, hospitalists, and intensivists often face difficulties due to the perceived autonomy of patients, therapeutic illusions, and miscommunications. To overcome these barriers, enhanced collaboration and models that allow shared decision-making between clinicians and surrogates are essential. Institutional support for early integration of palliative care can also foster an ethical climate, ensuring that patients receive high-quality care2.
Key Ethical Principles in End-of-Life Care
Physicians and healthcare professionals must navigate various ethical dilemmas in end-of-life care, including decisions about resuscitation, mechanical ventilation, artificial nutrition, terminal sedation, and euthanasia. The five guiding ethical principles in these situations are autonomy, beneficence, nonmaleficence, justice, and respect for persons. These principles help protect the rights, dignity, and well-being of patients, their families, and society3.
Nursing Ethics Perspectives on End-of-Life Care
Nurses are deeply involved in end-of-life care processes, providing continuous care and addressing ethical issues related to withholding or withdrawing life-sustaining treatments, palliative sedation, and euthanasia. Their patient-centered approach and expertise are crucial in developing ethically responsible care practices. Greater awareness and reflection on the specific roles and contributions of nurses can promote optimal care for vulnerable patients and their families4 5.
Ethical Considerations in End-of-Life Research
Research in end-of-life care is essential to improve palliative care standards and access. Ethical considerations in such research include distinguishing between research and quality improvement, assessing potential benefits and risks to subjects, evaluating decision-making capacity, and ensuring voluntariness in participation. Addressing these ethical aspects can help define the standard of care and enhance the quality of end-of-life care6.
Family-Centered Care in the ICU
Family-centered care is a comprehensive approach to managing end-of-life care in the ICU. It emphasizes the importance of the social structure surrounding patients and involves practical and ethical aspects of withdrawing life-sustaining treatments, using sedatives and analgesics, and easing the suffering of the dying process. Improved communication with families and the development of bereavement programs are also crucial components of this approach9.
Strategies for Handling Ethical Problems
Healthcare professionals often face ethical problems in end-of-life care, such as uncertainty and the need for unanimity in decision-making. Strategies to handle these problems include using the concept of "the patient's best interests" as a starting point for ethical reasoning. However, this concept needs to be explicitly defined to be effectively used in clinical decisions. Strengthening argumentation and reflecting on ethical values like dignity can help carers make ethically grounded decisions10.
Conclusion
The ethics of end-of-life care encompass a range of challenges and considerations, from ethical advocacy in nursing to the integration of family-centered care in the ICU. By adhering to ethical principles, enhancing collaboration, and addressing ethical issues in research and clinical practice, healthcare professionals can ensure that patients receive compassionate and ethically responsible care at the end of life.
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Most relevant research papers on this topic
Ethical advocacy in the end-of-life nursing care: A concept analysis.
Ethical advocacy in end-of-life nursing care involves adhering to ethical principles, championing social justice, safeguarding patient's rights, and involving hospital ethics committees for optimal ethical governance.
Systematic ReviewPalliative, Ethics, and End-of-Life Care Issues in the Cancer Patient.
Enhanced collaboration, shared decision-making, and early integration of palliative care can foster an ethical climate in end-of-life care for cancer patients.
Ethical considerations at the end-of-life care
Physicians must protect patients' rights, dignity, and vigor in end-of-life care decisions, while respecting patients' wishes and avoiding suffering.
Rigorous Journal
Highly CitedDefining end-of-life care from perspectives of nursing ethics
End-of-life care should be defined from nursing ethics perspectives, encompassing a broader range of people and addressing current terminology limitations.
Highly CitedNursing ethics perspectives on end-of-life care
Nurses play a crucial role in end-of-life care processes and play a crucial role in promoting ethically responsible nursing care for vulnerable patients and their families.
Ethical considerations in end-of-life care and research.
Ethical considerations in end-of-life research should guide the design and conduct of studies to improve access to quality palliative care and define standards of care.
Highly CitedEthics perspectives on end-of-life care.
Aggressive medical management of terminally ill patients raises ethical concerns, with autonomy, beneficence, and justice principles playing key roles in research and national initiatives to improve end-of-life care.
Jewish medical ethics and end-of-life care.
Jewish medical ethics and end-of-life care principles are compatible with palliative medicine and end-of-life care, with the exception of euthanasia and terminal illness.
Recommendations for end-of-life care in the intensive care unit: A consensus statement by the American College of Critical Care Medicine
End-of-life care in ICUs should be family-centered, centered on ethical concepts, and supported by comprehensive bereavement programs.
Highly CitedStrategies for handling ethical problems in end of life care: obstacles and possibilities
Stroke team members face both obstacles and possibilities in using ethical strategies to care for patients facing sudden and unexpected death from stroke, with uncertainty being a major obstacle and unanimity as a possibility.
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