Bioethics in Faith and Practice, Volume 1, Number 1

Bioethics in Faith and Practice ⦁ 2015 ⦁ Volume 1 ⦁ Number 1 15 An Ethical Framework for End-of-Life Discussions Rev. Mark E. Lones, D.Min. Chaplain Resident, Advocate Lutheran General Hospital Introduction: The primary goal of medical care is to assist patients to address medical issues which may threaten their health in order to preserve and restore the quality of the patients’ life. However, when a patient’s prognosis for meaningful survival is poor, there is a change in focus from restorative care to palliative care. Many patients fear that in the last stages of an illness, they may receive more high-tech medical care than they desire. However, once patients experience these final health stages, they are often more willing to accept aggressive treatments with limited benefits. Presently, there is a strong and growing public and professional interest in improving medical end-of-life decision making. The transition from “cure to comfort” is one of the most challenging and important medical care decisions the patient and family may encounter. Truog underscores two reasons why this transition is so arduous. “First is the widespread and deeply held desire not to be dead. Second is medicine’s inability to predict the future, and to give the patients a precise, reliable prognosis about when death will come. If death is the alternative, many patients who have only a small amount of hope will pay a high price to continue the struggle”. i The purpose of this article is to help give patients, families and care-givers an ethical framework to effectively discuss treatment options, values, and preferences during the change from restorative care to palliative care. Rosenfeld suggests the current practice of end-of-life discussions falls far short of the ethical ideal for numerous reasons. Patients lack sufficient medical knowledge to make informed choices. Family members often do not understand the patient’s values and preferences. And, advance directives have been largely ineffective in clinical practice. Rosenfeld concludes, “The disparity between contemporary ethical standards and actual clinical practice may be a marker of poor quality in end-of-life care. Alternatively, it could suggest that ethical standards do not fully capture patients’ own goals for decision making during serious illness”. ii Factors that Affect End-of-Life Decision-Making: A survey of the literature reveals a dissatisfaction with patient/family involvement with end-of-life treatment decisions. Over the last couple of decades, there has been a paradigm shift in American culture from a paternalistic model of medical practice to an emphasis on patient autonomy. iii Respect for patient autonomy has become the core principle that influences physicians, patients, and family decision-making roles. Patients who lack capacity may have their choices guided by verbal and written statements (i.e. advance directives) they made prior becoming incapacitated. Patients may also appoint surrogates who are ethically and legally recognized to make assessments on the patient’s behalf. Bioethics in Faith and Practice vol. 1, no. 1, pp. 13-19. ISSN 2374-1597 © 2015, Mark Lones, licensed under CC BY-NC-ND ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )