Palliative Care Ethics A Companion for All Specialties

by Randall, Fiona; Downie, R. S.

• ISBN13: 9780192630681
• ISBN10: 0192630687
• Edition: 2nd
• Format: Paperback
• Copyright: 1999-08-05
• Publisher: Oxford University Press

Summary

Palliative care is a rapidly growing area within health care and one in which there are many ethical dilemmas. Chronically and terminally ill patients increasingly wish to take control of their own lives and deaths, resources are scarce and technology has created controversial life-prolongingtreatment. This book has been written by a clinician and a teacher and writer of health care ethics to provide all those who care for the terminally ill - doctors, nurses, social workers, physiotherapists, clergy and other carers - with the concepts and principles to assist them in difficultdecisions. A central theme, that technical expertise must be controlled by humane, non-technical judgements, runs through the challenging and thoughtful text. Palliative Care Ethics, in this second edition, is now more user- friendly and includes genuine case histories to illustrate ethical issuesin the real world. The authors have expanded the section on rationing in respnse to the changing health care environment and confront the issues of patient rights to a far greater extent..There is also a new chapter covering terminally ill children. As the philosophy of palliation is increasinglyrecognised to be important from diagnosis, the coverage of more general cancer care ethics has been much increased. 'An excellent book' Palliative Medicine 'A thorough reference for practitioners of palliative care' Toronto Medical Journal 'The authors tackle many delicate concerns withprofessional and human integrity' Journal of Medical Ethic

Table of Contents

Ethics and aims in palliative care	1	(29)
The senses of `ethics'	1	(2)
The main tradition	3	(2)
Teams and the nursing profession	5	(1)
Patients' rights and autonomy	6	(5)
Utility and justice	11	(2)
Compassion, the virtues, and self-development	13	(3)
The aims of palliative care: personal, intrinsic, and extrinsic	16	(5)
Whole person care	21	(4)
Relatives	25	(1)
Ethics and aims	25	(3)
Conclusions	28	(2)
The patient-carer relationship	30	(21)
The patient's aims in the relationship	31	(1)
The carer's aim in the relationship	32	(2)
`Relativity' in the carer-patient encounter	34	(5)
Models of the carer-patient relationship	39	(8)
Consent	47	(3)
Conclusions	50	(1)
The relative-professional relationship	51	(28)
The relatives as co-carers	52	(6)
The relatives as decision makers	58	(8)
The relatives as beneficiaries of professional care	66	(11)
Attitudes in the relative-professional relationship	77	(1)
Conclusions	77	(2)
Teamwork	79	(24)
Why do we work in teams?	79	(3)
Common problems in specialist palliative care teams	82	(5)
Patient-centred or management-centred teams	87	(3)
Working in a patient-centred team	90	(2)
Collective responsibility	92	(1)
Moral conflict in the team	93	(6)
Moral deficiency	99	(1)
Caring for each other	100	(2)
Conclusions	102	(1)
Process of clinical decision making	103	(25)
Responsibility and outcome	104	(3)
Responsibility and process	107	(11)
Three logical distinctions in decision making	118	(6)
Formal guides to clinical decision making	124	(3)
Conclusions	127	(1)
Giving information	128	(22)
The professional responsibility	129	(3)
Whom do we tell?	132	(2)
The influence of relatives	134	(6)
How the truth is told	140	(1)
Standards of disclosure	141	(2)
Moral difficulties in giving information	143	(5)
Conclusions	148	(2)
Confidentiality	150	(14)
The moral basis for rules of confidentiality in palliative care	150	(1)
What constitutes confidential information?	151	(1)
Sharing confidential information	152	(3)
Disclosure of information to third parties	155	(3)
Confidentiality and the non-autonomous patient	158	(1)
Justifications for infringements of confidentiality	159	(4)
Conclusions	163	(1)
Clinical treatment decisions	164	(35)
Distinctions between medical treatment and care	164	(2)
Benefits to burdens/risks calculus	166	(2)
Obligations and options in treatment decisions	168	(2)
Life-prolonging treatments	170	(12)
Treatments to alleviate suffering	182	(4)
The role of relatives	186	(3)
Conflicts of interest between patients	189	(1)
Reassessment of treatment decisions	190	(1)
Autonomous to non-autonomous conditions	190	(1)
Advance statements and proxy decision makers	191	(6)
Conclusions	197	(2)
Other management decisions	199	(17)
Problems of autonomy and competence	199	(4)
Alternative therapy	203	(2)
Place of care	205	(4)
Quality of care	209	(6)
Conclusions	215	(1)
Emotional care	216	(20)
Consent to psychosocial and spiritual care	219	(2)
Communication of thoughts and emotions	221	(4)
Assessment of psychosocial and spiritual status	225	(2)
Assessment of psychosocial needs	227	(3)
Interventions in psychosocial and spiritual care	230	(2)
Counselling and counselling skills	232	(2)
Conclusions	234	(2)
Research	236	(12)
Codes of ethics	236	(1)
Randomized double-blind controlled trials	237	(2)
Local research ethics committees	239	(2)
Consent	241	(1)
Special ethical problems of research in palliative care	242	(5)
Conclusions	247	(1)
Resource allocation	248	(21)
The concept of need in palliative care	248	(4)
Macroallocation of resources	252	(8)
Microallocation of resources	260	(7)
Conclusions	267	(2)
Reply to critics	269	(19)
The moral distinction between killing and letting die	270	(8)
The problems of supremacy of patient autonomy	278	(8)
Emotional care	286	(2)
Quality and value of life	288	(18)
Values and valuing	288	(3)
Quality of life	291	(1)
Sisyphus	292	(3)
Choice	295	(1)
Happiness or well-being	296	(2)
Society and material needs	298	(1)
Society and culture	299	(1)
Incommensurability and scales	300	(2)
The value of life	302	(4)
References	306	(3)
Index	309