The fundamental objectives of the healthcare management profession are to maintain or enhance the quality of life, dignity, and well being of every individual needing health care services; and to create a more equitable, accessible, effective and efficient healthcare system.Ethical issues near the "end of life" (EOL) often arise because of concerns about how much and what kind of care makes sense for someone with a limited life. If the patient is very old. There is often conflict between physicians or nurses and family members about what is the appropriate care for the patient. (Whether to sustain ones life or to let it perish)
I am not sure I understand your question. Are you are suggesting that you'd conduct an experiment in which some individuals at the EOL receive an intervention of some sort, while others do not, and then you'd determine the cause of death afterwards? This doesn't make much intuitive sense to me, so clarification would be necessary.
There are several issues that arise with EOL care. The most prevalent issue is that of what should be the appropriate care approach for people at EOL. The camps are divided between those who feel that heroic measures should always be taken vs those who feel that patients should receive hospice care and die with dignity and respect. The research shows that those who enter hospice care actually live longer and feel more at peace than those receiving heroic measures. Moreover, from a health system's perspective, heroic measures are waste of valuable resources.
Thanks for clarifying, Joey. So if I understand correctly, you are particularly interested in knowing if there are ethical concerns over determining cause of death when these EOL decisions were being explored? If so, then I don't think there is an ethical decision. The problem is in determining the cause of the death and assigning that cause to the choice made at EOL. In reality, all of these individuals will die - and they will die because of their medical condition. So I am not sure how ethical issues in qualifying the cause of death would arise? That said, I am sure there will be lawsuits that stem from families who believe that the death was preventable or avoidable.
Joey, you are right about the conflict and this is definitely a very important topic in history. There is a conflict of professionalism and moralism instilled in this whole process. And somehow, when healthcare professionals take on the professionalism hat, moralism is pushed aside and when this happens, family members try to instill moralism in healthcare professionals. Even when professionalism and moralism exist in an individual, somehow we are very quick to ascertain the situation as "hopeless" and let scientific conclusions kick in. And we further convince ourselves that any action taken will be in vain and that the family members are blinded: they will see the reality once the moment of truth comes. I believe this topic could potentially flourish in light of the study of moral conscience and how healthcare professionals face conflicting influences between professionalism and moralism.
Because of the advances in medicine over the last 80 years, it has become more difficult to KNOW when someone is dying. I have been within the hospice movement now for 36 years and currently working with older people in care homes - most of whom have advanced progressive incurable diseases i.e. dementia. The ethics of prolonging life are an issue in this population as care homes in the UK have come from a background of a 'rehabilitative' focus rather than that of palliative care. Seeing 'penumonia as the old man's friend' (as I was taught in nursing school) as a release rather than a condition that has to be treated at all costs is very important. Of course a penumonia when the quality of life is good must be treated in older people. But when one is bed-bound with advanced dementia penumonia is often how frail older people die. AFter discussion with staff in the care home and the family (and resident, if they are able) about the situation there comes a point when the most humane and dignified care is to allow the person to die.... We have documents in the UK where conversations during the last year of life are documented about the person's wishes as they approach the end-stage of their life. This is really important for frail older people who need to make their wishes known in case a dementia prevents them in the future. Hope this helps.... Jo
there is no issues of ethics......the best possible way is to provide optimal healthcare and relief to patient...death is inevitable .... give him the hope and do the best for solving aging problems....the best way is to give them freedom