Neobook — clinical reference

Introduction

We recognise that patients diagnosed with life-threatening or terminal illness are vulnerable in their emotional state and dependence on their health care professionals (& non-professionals) for compassionate empathetic care, sensitive sharing of information to promote participation in decision-making and effective symptom management. It is essential that HCPs caring for patients with life-threatening illness base their care on sound ethical principles & practice. The following is an outline of ethical principles as applicable to end-of-life care.

Beneficence and Non-maleficence

Treatment can only be justified if there is benefit to the patient
In clinical care, balance benefit of treatment vs risk of treatment
If there is no longer any benefit to the patient withholding or withdrawing treatment is a sound medical decision which may be reached in discussion with patient, family and carers
Try to ensure continuity of care and appropriate referral if you are no longer the treating clinician
A principle of palliative care is non-abandonment, there is always an appropriate treatment plan
Referral to hospice or palliative care service if symptom control is not achieved within time frame specified in individual care plan.
Rigorous & effective professional education of HCPs to develop competence in palliative care will promote beneficence, as will effective medical & palliative care research

Respect for autonomy (self-rule)

Promote patient understanding to be able to provide informed consent
providing sufficient information to enable a person to participate fully in decision-making
promotes confidentiality and privacy
Respects a person's refusal of treatment following sharing of information with the person concerned
Patient autonomy is based on good communication, and promoting of patient’s understanding
Empowerment combines autonomy and beneficence

Justice

Distributive justice
- distribution of scarce resources
Rights based justice
- equal access to health care
- right to palliative care
- right to pain and symptom control
- right to competent, trained clinician
Legal justice
- in accordance with the laws of the state