3 Lembaran Kerja Askep KGD
3 Lembaran Kerja Askep KGD
3 Lembaran Kerja Askep KGD
Review
Ethical Issues Surrounding End-of-Life Care:
A Narrative Review
Sameera Karnik 1 and Amar Kanekar 2, *
1 American Public University, 111 West Congress Street, Charles Town, WV 25414, USA;
sameera.karnik@gmail.com
2 School of Counseling, Human Performance and Rehabilitation, University of Arkansas at Little Rock,
2801 South University Avenue, Little Rock, AR 72204, USA
* Correspondence: axkanekar@ualr.edu; Tel.: +1-501-683-0512
Abstract: End-of-life care decision making carries paramount importance due to the advancements
in medical sciences. Since medical science has evolved over the time and now has a potentiality to
reshape the circumstances during death and in turn prolong lives, various ethical issues surround
end-of-life care. The purpose of this narrative review is to discuss issues such as autonomous decision
making, importance of advance directives, rationing of care in futile treatments and costs involved
in providing end-of-life care. Even though much progress has been made in this area continued
advancement in medical science demands further research into this topic.
1. Introduction
All human-beings are mortals and hence death is an inevitable occurrence. Advancements
in medical technology are changing the norms of natural death. These technologically advanced
treatments have a capability to intervene at the time of death and prolong the lives of people. Medical
technologies are facilitating to reshape the circumstances around natural death, by sustaining human
lives. Even though medical treatments have advanced technologically they hold no promises for
recovery, they can sustain life with or without meaningful existence or with secondary support (like
feeding tubes, ventilators, etc.). Hence, these medical advancements have empowered patients and
their families (proxies) with an important task of choosing their treatment preference during end-of-life
care [1].
“Decision-making” for end-of-life care has earned paramount importance as it has capability
to prolong human life with the support of medical technologies or can let the natural death process
continue by foregoing the treatment option [2]. Hence, end-of-life care is facing various ethical
dilemmas. The purpose of this narrative review is to discuss issues such as autonomous decision
making, importance of advance directives, rationing of care in futile treatments and costs involved
in providing end-of-life care. This is a US centered study and the text does not necessarily apply to
countries and contexts outside the United States.
effective since 1991 has facilitated communication between the healthcare providers and patients or
consumers [4]. The person’s right to autonomously voice their end-of-life treatment choices has to
be respected ethically considering the use of advance treatments and their prognosis. This right of
autonomy has some limitations, and hence faces an ethical dilemma. The healthcare professional
should respect the patient’s autonomy while considering its limitation and carry out their duties to
benefit the patient without doing harm [5].
Even though we are discussing about patients right to autonomy we are talking about its
limitations. To elaborate further, autonomy gives patients’ a right to control their treatment according
to their preferences, though many a times their autonomy is not respected. They receive end-of-life
care which is in-consistent with their end-of-life care preferences [6]. This gives importance to the
ethical issue of autonomy surrounding end-of-life care preferences.
medical situation as the patient may have evaluated but it is seen that they are not very good at taking
end-of-life decisions for the patients.
Families playing the crucial role of surrogate or proxy are emotionally attached to the incapacitated
patient and hence their moral interest (emotional, financial pressure, etc.) may be diversified in opting
for a treatment or declining them [4]. The unstable advance preferences may not be authentic in some
eventful situations. Hence, the medical situation may need renewed evaluation and decision making.
To address these ethical and legal issues arising from advance directives there is a need to educate
the general population about the legal requirements and rights of the patient to accept or refuse a
recommended treatment and advance directive. The information about proper implications and use of
advance directives can facilitate in understanding and addressing legal issues arising from planning
ahead by the patient or by the primary care givers [4].
knowledge about advanced treatment implications and improved healthcare decision making from
patients, their families and physicians [7].
3. Policy Implications
The task of healthcare executives to manage ethical issues surrounding end-of-life care is
challenging. Healthcare executives can address these ethical dilemmas ensuring certain policies
to be followed during managing this task. They can guide the patients and their surrogates to make
informed treatment preferences by providing them trustful information, appropriate prognosis and
available options regarding the case specific treatment choices. They can assist the patient and their
families to make a well judged end-of-life care decision and document their preferences. In case there
is a disagreement between the healthcare provider and the patient or surrogate end-of-life care choices,
then they can take appropriate steps by appointing an ethics committee to address this ethical or legal
issue and document its proceedings. Healthcare executives can compile policies, so as to introduce,
promote, and discuss the use of advanced directives as an admission procedure [1]. This can motivate
the patients to make a living will (advanced directive) about their end-of-life care preferences which in
due process can facilitate families to make appropriate decisions in case of incapacitated patients.
Healthcare 2016, 4, 24 5 of 6
Healthcare organizations can work towards developing and implementing guidelines & policies
for end-of-life care decision making, especially policies for withholding or withdrawing the treatment
options so as to avoid the ethical dilemmas. There should be a proper disclosure mentioning the
limitations of certain specific treatment options if there are any, so that the patients and families are
well informed about their treatment options and make well-judged decisions. Healthcare executives
can develop resources supporting palliative treatment care choices. They can additionally provide
detailed information and knowledge about these palliative care options so as to facilitate patients
and their families to make a competent end-of-life care preference. Healthcare organizations can
provide effective support by appointing an interdisciplinary ethics committee and employee assistance
facility available so as to address any ethical crisis [1]. A well-formed, consistent and integrated
ethics committee can safeguard organization’s future by increasing patient satisfaction, increasing
organizations productivity, avoiding unethical activities, restricting undue costs, and reducing the risk
of lawsuits [11].
References
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© 2016 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access
article distributed under the terms and conditions of the Creative Commons Attribution
(CC-BY) license (http://creativecommons.org/licenses/by/4.0/).