L21 Ethical and Legal Issues in end-of-life care (Prof Faisal)
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The document discusses ethical and legal issues in end-of-life care, emphasizing the balance between patient autonomy and the doctor's obligation to act in the patient's best interest. It outlines scenarios where withholding or withdrawing treatment is justified, including clinically-assisted nutrition and hydration, and emphasizes the importance of team agreement on treatment futility. Ultimately, it stresses the need for sensitive discussions and responsible resource allocation in end-of-life decisions.
L21 Ethical and Legal Issues in end-of-life care (Prof Faisal)
- 1. ETHICAL AND LEGAL ISSUES IN END-OF-LIFE CARE PROF. FAISAL GHANI SIDDIQUI
- 2. Ethical dilemmas for the end-of-life almost always involve decisions to WITHHOLD / WITHDRAW TREATMENT
- 3. WHEN THE PATIENT AND DOCTOR AGREE there is no benefit in carrying on or starting a new intervention THE RIGHT ACTION IS CLEAR . . . though skill is required on the doctor's part to manage these discussions sensitively
- 4. when patient requests to continue or initiate a treatment BUT . . . It is not in the benefit of the patient? WHAT TO DO?
- 5. THERE ARE LIMITATIONS TO PATIENT AUTONOMY PATIENTS CANNOT DEMAND a treatment that is not in their best interests and doctors need not strive to preserve life
- 6. THE DOCTOR IS JUSTIFIED IN WITHHOLDING / WITHDRAWING INTERVENTION WHEN; • It is PATIENT'S DECISION to withhold a life-saving intervention • HARMS OF TREATMENT outweigh any potential lengthening of life • the treatment will not achieve its SPECIFIED AIM • It results in unnecessary / unequal distribution of RESOURCES • Requires doctor to act AGAINST A PROFESSIONAL CODE OR LAW
- 9. CLINICALLY ASSISTED NUTRITION AND HYDRATION • Hydration and nutrition is ESSENTIAL FOR HUMANS • Families and doctors FIND IT DIFFICULT TO WITHDRAW clinically assisted hydration and nutrition up to the end of life of patient • When nutrition and hydration become clinically-assisted, they are CLASSED AS A TREATMENT rather than basic care • Hence as treatment when they cease to offer overall benefit, THEY CAN BE WITHDRAWN
- 11. CARDIOPULMONARY RESUCITATION • MAY FAIL TO RESTART THE HEART as patients approach the end of their lives, or • may result in a SHORT PERIOD of impaired quality of life
- 12. Agreement should be reached among the multidisciplinary team that this is a FUTILE EXERCISE And decision carefully recorded and conveyed
- 13. IN SUMMARY • Patient autonomy has limits • Doctor should be mindful of other responsibilities; • To benefit and not harm the patient • To use resources justly