What Is Ethical End-of-Life Care?

The care of elderly persons and those facing the end of life due to a life-limiting illness presents some unique challenges for care providers. These include but certainly aren’t limited to the need to maintain patient autonomy in the face of “broken” communication (e.g. when the patient can’t speak for themselves); the need to balance “goods and harms,” and the need to elicit goals of care and optimize quality of life. 

Although every situation is unique, there are certain guiding principles that are a hallmark of ethical end-of-life care. These can be summed up as follows:

• The overarching goal of ethical end-of-life care is to provide care that is consistent with the dying person’s values, goals, and preferences in a compassionate, nonjudgmental, and respectful way. 
• Communication with the patient and/or their surrogates should be honest, open, and transparent. Care providers need to communicate promptly and sensitively about changes in the patient’s condition that may impact goals of care. 
• Before beginning any treatment, doctors should make every effort to elicit the patient’s wishes either through verbal discussion or an advance directive and/or POLST. When the patient cannot speak for themselves, and there is no advance directive, surrogate decision makers should be provided the information they need to make informed decisions based on their knowledge of the person’s preferences, values, and goals. These include the decision to forego treatment and pursue palliative or hospice care. 
• Family members and other loved ones should be encouraged to interact with the dying person to provide emotional comfort and support.
• Care should be provided in a way that respects and honors a person’s cultural and spiritual or religious beliefs.
• End-of-life care should minimize suffering and physical discomfort to the greatest extent possible. When issues around risks and benefits arise (e.g., when escalating doses of painkillers might hasten the person’s death) care providers should seek input from all stakeholders (including the healthcare team) to determine a course of action that is in the patient’s best interests. 

When ethical concerns arise that cannot be resolved with input from the patient, their surrogates, and members of the healthcare team, any stakeholder (the patient or his loved ones, a care provider or a disinterested third party) can request an ethics consult, which will allow trained intermediaries with expertise in bioethics to step in and help guide decisions about care. 

Sources

“Ethics consultations”. AMA Code of Medical Ethics. https://code-medical-ethics.ama-assn.org/ethics-opinions/ethics-consultations