Date: 07/27/2009
Final
Factors Contributing to Ethical Dilemmas
HOSPICE AND PALLIATIVE CARE
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02:32 PM -- Factors Contributing to Ethical Dilemmas
The committee reconvened. Ms. Susan Fox introduced herself and stated that her presentation addresses ethical dilemmas regarding end-of-life decisions. She stated that she was the only American to receive a master's degree in bioethics from the University of Leuven, Belgium. She stated that she was going to provide an overview of several issues that many family members, physicians, and other entities deal with regarding end-of-life decisions.
She highlighted that religions have different foundations for their ethical compass which leads to the "right" way to do something. She stated that there is not one singular ethical code. She described several current hot button ethical dilemmas that doctors, families, and various other actors evaluate at some point regarding end-of-life decisions. These hot button ethical dilemmas include:
- Advanced care planning. She stated that advanced care planning requiring people to make choices ahead of time regarding what to do at the end of one's life. She stated that not every form describing an individual's desire at the end of life is going to work for every person.
- Artificial hydration or tube feeding. She stated that this ethical dilemma requires individuals to decide whether they want to continue to receive nutrition to support life in circumstances where a patient is near death or brain dead.
- Brain death. Ms. Fox stated this ethical dilemma requires physicians and families to decide how long to keep a person's body alive when the person may be brain dead.
- Capacity and competence. This ethical dilemma includes making decisions about when an individual is unable to make decisions for him or herself. She stated there are several circumstances in which a family or a physician is put in a position to make decisions for individuals who are unable to do so for themselves.
- Cultural issues. This ethical dilemma includes respecting different ways in which individuals die and are buried. She spoke to how mandating specific forms could easily violate specific cultural beliefs.
- Disabled patients. She described some of the ethical dilemmas that this population deals with and stated that this population has unique ethical concerns.
- Do Not Resuscitate (DNR) orders. She spoke to instances where DNR orders were in place and still there were questions regarding end-of-life decisions. She stated that in instances where there may be a DNR order, there can still be ethical dilemmas.
- Futility. She referred to the Code of Ethics that medical doctors adhere to and stated that there is a ethical statement in the code regarding futility. She stated that most physicians are taught to 'cure' patients. She stated that physicians have a hard time crossing over into the realm of palliative care versus curative care.
- Indigent patients or "unbefriended" patients. She stated that unbefriended patients have no representatives, court appointed guardians, or decision maker available to represent their desires. She spoke to the proxy decision maker law in Colorado that allows close friends or interested persons to make decisions for ill patients. She stated that the ethical dilemma in these situations can be difficult as there is no guidance from the patient as to his or her desire at the end of life.
- Pain management. She stated that there are several ethical dilemmas regarding how much pain medication to give a patient.
- Suicide. She stated that ethical and legal issues arise around refusal of treatment, assisted suicide, and committing suicide. She explained that the U.S. constitution allows individuals to refuse any unwanted medical treatment.
- Trade offs. She stated that end of life care is not just about making decisions about the patient's life, but also about monetary resources, educational concerns, and public health effects.
03:12 PM
There was some discussion around who makes decisions regarding end of life and legislation. She encouraged the committee to have a real discussion surrounding artificial hydration. She stated that it could be beneficial for many patients. The committee discussed the "hot button" issues with Ms. Fox. Various other issues were discussed such as organ donation and organ transplants.