With the influential development of patient autonomy and the right to self-determination, a patient’s religious affiliation constitutes a key component in medical decision making. 15– 17 Opioids and sedatives when used in line with best practice rarely require such high doses as to risk shortening life.Religion and spirituality have always played a major and intervening role in a person’s life and health matters. This traditional argument has come under increasing challenge ( Tables 3 and and4 4). In the classic interpretation, a patient is in pain, a higher dose of opioid is given to relieve that pain, but at the same time in the belief that this may shorten life. The DDE states that an action (such as an increase in opioid dose) that the professional foresees may shorten life – but does not intend to have that result – is justified provided that the intention is to benefit the patient and not shorten their life. The doctrine of double effect (DDE) provides justification for such a consequence, but raises concern that it may protect dangerous practice. The frequent misconception among professionals is that the life of the patient may be shortened by increasing doses of these drugs in line with accepted clinical practice – a belief often shared by patients and their families. Opioids and sedatives provide effective relief for the frequently distressing symptoms of pain, dyspnoea and agitation as the end of life approaches. Each potential intervention may be considered on its own merit as part of advance care planning.ĭouble effect and the use of opioids and sedation For patients dying at home it is likely that more explicit discussion of CPR is required for them and their relatives to ensure emergency services are not called inappropriately.ĭecisions not to attempt CPR refer only to CPR and should not influence other areas of decision making. A chance to air fears or concerns and make plans for their death would seem far more useful discussions to have, but the needs of patients who want to know more detail should also be met. An explanation that they are now dying may make further discussion about CPR itself irrelevant. Discussion is, however, required about the patient's understanding of their general situation and outlook. When CPR is considered a futile intervention, to discuss it with the patient would appear only to bring unnecessary distress. There are significantly more practical challenges, especially with regard to the unrealistic expectations of both public and professionals. Morally, there are few arguments that favour attempting CPR in the last days or weeks of life. 12, 13 Agreement should be reached among the multidisciplinary team that this is the situation and a decision carefully recorded. The doctor may be justified in withholding or withdrawing an intervention which as a result allows death to occur in the following situations:Īttempts at cardiopulmonary resuscitation (CPR) are unlikely to be successful in restarting the heart as patients approach the end of their lives or, if they are, may result in a short period of significantly impaired quality of life. However, when there is doubt the presumption must be in favour of preserving life. The legal position is clear that a patient cannot demand a treatment that is not in their best interests and that doctors need not strive to preserve life at all costs. Respecting the autonomy of a patient who is requesting to continue or initiate a treatment needs to be challenged when it would result in overwhelming harm, an unnecessary and unequal distribution of resources or an action that requires the doctor to act against a professional code or the law. 5 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. Ethical dilemmas approaching the end of life commonly revolve around decisions to withhold or withdraw interventions or treatment.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |