palliative care and ethics

what is an example of a rapid decline trajectory in palliative care

cancer, once irreversible the spread and consequent deterioration is rapid

what is an example of a slower decline trajectory in palliative care

frailty

longer lasting

functional factors decline

what are the 6 ambitions for palliative and end of life care

each person is seen as an individual

each person gets fair access to care

maximising comfort and wellbeing

care is coordinated

all staff are prepared to care

each community is prepared to help

what is the reference for the 6 ambitions of palliative and end of life care

NHS

What is WHO 2020 definition of palliative care

an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual

what does WHO 2020 say the aims of palliative care should be

• Provides relief from pain and other distressing symptoms

• Affirms life and regards dying as a normal process

• intends neither to hasten or postpone death

• Integrates the psychological and spiritual aspects of patient care

• Offers support to help patients live as actively as possible until death

• Supports family to cope during the patients illness and in their own bereavement

• Team approach to address the needs of patients and their families

what questions can be asked to differentiate palliative and end of life care

is there reversibility?

Is it ethical to prolong life? (Not if pt is actively dying)

what is the NICE 2019 definition of end of life care

Clinical care of adults (18 years and over) who are dying during the last 2 to 3 days of life. It aims to improve end of life care for people in their last days of life by communicating respectfully and involving them, and the people important to them, in decisions and by maintaining their comfort and dignity. It includes the management of common symptoms without causing unacceptable side effects and maintain hydration in the last days of life

what does Dying matters 2020 say about end of life care - what it is and what it should do?

• End of life care is support for people who are in the last months or years of their life

• End of life care should help you to live as well as possible until you die and to die with dignity

How does palliative vs end of life care change my care of a patient?

would I be surprised if the person in front of me died in the next year?

If yes, my priorities of care change, think about how they want to die, wishes, family etc.

what are commonly reported symptoms before death

• Pain

• Dyspnoea

• Nausea/vomitting

• Anorexia

• Altered taste

• Confusion

• Agitation/restlessness

• Noisy breathing

• Urinary incontinence / retention

• Dry/sore mouth

• Fatigue

what factors should affect our ethical decisions?

• Religion

• Intuition

• Cultural norms

• Laws and policies

• Professional codes of conduct

• Coercion

what is consequentialism

• Is an action right or wrong by the action is produces

what is ulititariansim

greatest good for the greatest number

what is deontology

certain things are right or wrong regardless of consequence

what are the 4 ethical principles

• Autonomy

• Beneficence

• Non maleficence

• Justice

what does the mental capacity act 2006 say about capacity

• Presumption of capacity

• Individual needs to be supported to make their own decision

• People have the right to make decisions that might seem unwise

• If lacks capacity decisions must be made in best interest

• Someone who acts on persons behalf must consider decisions that would interfere less with persons rights or freedom of actions

what legislation and guidance advises on ethics

• Clinically assisted nutrition and hydration and adults who lack the capacity to consent BMA

• Treatment and care towards the end of life: good practice in decision making- GMC

• Supporting people who have eating and drinking difficulties: a guide to practical care and clinical assistance, particularly towards the end of life- Royal college of physicians 2021.

is clinically assisted nutrition and hydration medical treatment or basic care?

medical treatment BMA

when would CANH not be appropriate

when no clinical benefits and carried potential risks and CANH not expected to prolong life

e.g. end stage dementia

what is an advanced directive/ director/ decision

a decision a patient makes in advance about their care, there is a criteria to be met and is usually seen in patients with long term degenerative diseases.

what does a power of attorney have power over

health and welfare and/or wealth

only used when someone lacks capacity