Autonomy and its implications for palliative care: A northern European perspective

Farsides, Calliope

doi:10.1191/026921698674833709

Cited by 7 publications

(7 citation statements)

References 3 publications

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“…Popular support for the right to and legalization of euthanasia is often discussed in relation to societal endorsement of the ethical principle of autonomy 14,15. Some have argued that a patient’s right to self-determination regarding death is necessary to ensure a balance between the increasing availability and use of life-prolonging technology in modern medicine, and a desire for a more holistic approach to end-of-life care 15,16.…”

Section: Discussionmentioning

confidence: 99%

Concerns About End-of-Life Care and Support for Euthanasia

Givens

Mitchell

2009

Journal of Pain and Symptom Management

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Popular support for euthanasia is known to vary according to sociodemographic characteristics. However, little is known about whether support is associated with concerns regarding the emotional, physical, and economic burdens of end-of-life care. This study used data from the 1998 General Social Survey, a national survey of community-dwelling adults. The outcome variable assessed the respondents' support for a doctor's right to end life in the setting of terminal illness. Independent variables assessed the following concerns: 1) concern about the emotional burden of end-of-life decision making for family members; 2) worry about the economic burden of terminal illness; 3) concern about pain at the end of life; 4) worry that lack of money or insurance will result in secondclass end-of-life care; and 5) belief that their religious community will be helpful at the end of life. Multivariable logistic regression estimated the independent effect of these concerns on support for euthanasia, adjusting for sociodemographic characteristics. Of 786 respondents, 70.6% approved of euthanasia in the setting of terminal illness. In adjusted analyses, respondents with concerns about the emotional toll of decision making on family members, economic burden, and poor health care because of lack of insurance were significantly more likely to support euthanasia. Respondents with faith in the helpfulness of their religious community were less likely to support euthanasia. In conclusion, emotional and economic concerns about end-of-life care were associated with support for the right to euthanasia. Future work can evaluate whether alleviating these concerns may reduce the perceived desire for euthanasia by patients near the end of life.

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Section: Discussionmentioning

confidence: 99%

Concerns About End-of-Life Care and Support for Euthanasia

Givens

Mitchell

2009

Journal of Pain and Symptom Management

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“…Palliative care practitioners have historically tended to be opposed to the legalisation of any form of euthanasia, arguing that improved provision of palliative care would reduce the demand for euthanasia and that legalised euthanasia might be used by governments as a substitute for adequate funding of palliative care. 11 This opposition to voluntary euthanasia is already in tension with palliative carers' commitment to the promotion of autonomy, as others have noted (Farsides, 1998;Woods, 2002). The narrative view gives additional force to the view that the patients themselves should decide whether it is in their interest to continue living.…”

Section: The Challenge To Palliative Carersmentioning

confidence: 88%

Palliative Care and the QALY Problem

Hughes

2005

Health Care Anal

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Practitioners of palliative care often argue for more resources to be provided by the state in order to lessen its reliance on charitable funding and to enable the services currently provided to some of those with terminal illnesses to be provided to all who would benefit from it. However, this is hard to justify on grounds of cost-effectiveness, since it is in the nature of palliative care that the benefits it brings to its patients are of short duration. In particular, palliative care fares badly under a policy of QALY-maximisation, since procedures which prevent premature death (provided the life is of reasonable quality) or improve quality of life for those with longer life expectancy will produce more QALYs. This paper examines various responses to this problem and argues that in order to justify increased resources for palliative care its advocates must reject the 'atomistic' view of the value of life implicit in the QALY approach in favour of a 'holistic' or 'narrative' account. This, however, has implications which advocates of palliative care may be reluctant to embrace.

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“…Assisting the patient to define and achieve goals and integrate meaning even when dying is part of this process and represents the desire to respect autonomy. Quality of life can only be judged by the patient and if professionals wish to ascertain the patient's views about this and to take seriously the moral demand to respect patient autonomy 13 then they may have a responsibility to discuss CPR with the patient.…”

Section: Is Cpr Ever Appropriate In the Context Of Palliative Care?mentioning

confidence: 99%

“…15 Finally, professionals ought to consider that some patients may be happy for their choices to be guided by others or indeed happy to relinquish them and allow others to make them on their behalf. 13 Neither this nor acting with compassionate beneficence substantially undermines the principle of respect for autonomy. Instead, they reflect the necessity of striving to achieve balance between competing ethical principles in the challenging area of palliative care.…”

Section: Discussing Cpr With Patients: Issues To Considermentioning

confidence: 99%

Cardiopulmonary resuscitation for palliative care patients: a discussion of ethical issues

Willard

2000

Palliat Med

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Medical advances have significantly improved the prognosis and life-expectancy for many patients with life-threatening illness. However, the ability to extend and prolong life increases the complexity of clinical decision-making, and this is particularly true in the context of palliative care. During the course of their illness, many patients with palliative care needs will require hospital admission. It is in this setting that ethical dilemmas are likely to arise regarding the use of life-prolonging measures such as cardiopulmonary resuscitation (CPR). This paper considers some of the ethical issues surrounding the use of CPR for palliative care patients in the hospital setting.

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Autonomy and its implications for palliative care: A northern European perspective

Cited by 7 publications

References 3 publications

Concerns About End-of-Life Care and Support for Euthanasia

Concerns About End-of-Life Care and Support for Euthanasia

Palliative Care and the QALY Problem

Cardiopulmonary resuscitation for palliative care patients: a discussion of ethical issues

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