End‐of‐Life Decision Making: Practical and Ethical Issues for Health Professionals

Cartwright, Colleen M

doi:10.1111/j.1741-6612.2000.tb00145.x

Cited by 16 publications

(12 citation statements)

References 14 publications

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“…Unfortunately patients seldom initiate the conversation, but nor do their physicians (Basile, 2002). Possible reasons for this include procrastination, dependence on the family for decision‐making, waiting for the physician to initiate a discussion with the patient or vice versa , poor wording in advance directive documents, lack of training of medical practitioners in discussing death and dying and fear by doctors of causing negative emotions on their patients (Cartwright, 2000; Stewart, 2005; Clayton et al. , 2007).…”

Section: Literature Reviewmentioning

confidence: 99%

Experiences with advance care planning: nurses’ perspective

Jeong¹,

Higgins²,

McMillan³

2011

Int J Older People Nursing

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Section: Literature Reviewmentioning

confidence: 99%

Experiences with advance care planning: nurses’ perspective

Jeong¹,

Higgins²,

McMillan³

2011

Int J Older People Nursing

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“…6,12,13 Involving families can be important given caregivers may override or misinterpret the healthcare consumer's wishes when there is no AHD in place. People in the US who have engaged in ACP, often with the support of a social worker, 14,15 report feeling more comfortable that they have addressed concerns about living in a burdensome state 16 and believe AHDs ensure them a sense of control and way of protecting their families from excessive burden.…”

Section: Introductionmentioning

confidence: 99%

Relinquishing or taking control? Community perspectives on barriers and opportunities in advance care planning

McLennan¹,

Boddy²,

Daly³

et al. 2015

Aust. Health Review

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Objective. This paper reports on the experiences and perspectives of community members in relation to advance healthcare directives and enduring power of attorney, including the factors that encourage or discourage engagement in advance care planning (ACP).Methods. A qualitative methodology was used involving 26 in-depth telephone interviews with community members (mean age 66 years). The aims of the interview question were to gain an understanding of: (1) motivations for engaging in ACP; (2) barriers that prevent people from engaging in ACP; and (3) suggestions for promoting ACP.Results. The findings suggest that: (1) community members lack knowledge about ACP; (2) forms appear inaccessible and complex; (3) community members avoid ACP due to fear, mistrust and concerns over control; and (4) there are misperceptions regarding the relevance of ACP based on age and health.Conclusions. There is unnecessary fear, avoidance and mistrust around ACP activities, largely resulting from misinformation. There is an undoubted need for greater education and support to be offered to individuals and their families regarding ACP, its benefits and its limitations.What is known about the topic? There is a lack of awareness about ACP in Australia, which is compounded by issues in the accessibility of ACP information, forms and support in completing the often complex documentation. Further, studies have indicated health practitioners tend to avoid assisting patients with ACP decision making and formalisation of their wishes for health care should they lose testamentary capacity. What does this paper add? This paper contributes further understanding of the experiences and perceptions of people, particularly older Australians, in relation to ACP, including the motivating and discouraging factors for people in the uptake of advance healthcare directives and enduring power of attorney. People felt discomfort and mistrust about ACP, and lacked understanding of its relevance regardless of age or health status. Those who had engaged in ACP, prompted by family members or experiences in, or witnessing, ill health, felt a sense of security in having formalised their wishes. What are the implications for practitioners? It is now clear that people require improved provision of information and support around ACP-related activities. This support may best be offered by practitioners such as nurses and social workers who are knowledgeable regarding ACP and skilled in counselling. Without discussion of death and dying, and the role of ACP, people will continue to feel a mistrust and avoidance towards formalising their healthcare wishes in advance.Additional keywords: advance directive, aging, community, death and dying, decision making, end-of-life issues, enduring power of attorney.

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“…Recent research by Bollig et al [9] and Bollig [71] highlights the ethical challenges surrounding decision-making and end of life care in nursing homes. Cartwright [112] argues "Health professionals need to understand the fears and concerns of their patients, their preferred place to die and to respect patient autonomy" (p. 57). Cartwright also identifies the need to activate changes in the professional preparation of health professionals associated with management of pain and end-oflife decision making:…”

Section: Discussionmentioning

confidence: 99%

Aging, Informed Consent and Autonomy: Ethical Issues and Challenges Surrounding Research and Long-Term Care

Seedsman¹

2019

obm geriatr

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The history surrounding the notion of 'informed consent' is provided in the interest of setting a framework for the emergence of an ethics of aged care. Informed consent negligence is seen as a breach of duty involving potential litigation through the legal concept of 'failure to warn'. Respect for the autonomy of older persons is highlighted as a cornerstone of care by medical professionals and family members. There remains the challenge, however, of caring for older people who do not have full decision-making capacity. Research involving older people creates a range of ethical issues that warrants the use of best practice principles that respect the autonomy, integrity, dignity and safety of older participants. The use of restraints as part of aged care is demonstrated to have implications for infringements of human rights. While promoting the importance between communication and ethics of care, a case is made for the adoption of a person-centred approach that acknowledges both the autonomy and personhood of older people. In relation to the quality of aged care and safety, the message for all caregivers is to ensure that all decisions large or small incorporate a genuine mix of ethical reflection, avoidance of unnecessary risks and prudent judgement that leads to the most beneficial course of action.

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End‐of‐Life Decision Making: Practical and Ethical Issues for Health Professionals

Cited by 16 publications

References 14 publications

Experiences with advance care planning: nurses’ perspective

Experiences with advance care planning: nurses’ perspective

Relinquishing or taking control? Community perspectives on barriers and opportunities in advance care planning

Aging, Informed Consent and Autonomy: Ethical Issues and Challenges Surrounding Research and Long-Term Care

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