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Ethics in Palliative and End-of-Life Care

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Essentials of Palliative Care

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Abstract

In treating patients with terminal disease, physicians are faced with multiple situations that require balancing a respect for life with the dying process and the inevitable death of the patient. Difficult decisions must be made, but with proper utilization of the principles of ethical conduct and the “Rule of Double Effect” moral and ethical dilemmas can be avoided. In this chapter, the principles of ethical conduct will be discussed in association with moral obligations, legal limitations, and protections provided to the physician dealing with end-of-life care.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Jack M. Berger M.S., M.D., Ph.D.

Authors
  1. Jack M. Berger M.S., M.D., Ph.D.
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Corresponding author

Correspondence to Jack M. Berger M.S., M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Yale University, New Haven, 06520, Connecticut, USA

    Nalini Vadivelu

  2. Citrus Road 278, River Ridge, 70123, Louisiana, USA

    Alan David Kaye

  3. Keck School of Medicine, Department of Anesthesiology, Pain Medic, of the University of Southern California, Los Angeles, 90035, California, USA

    Jack M. Berger

Appendices

Review Questions

  1. 1.

    The number of seriously ill patients who experience “substantial” pain ranges from…

    1. (a)

      36–75%

    2. (b)

      5–10%

    3. (c)

      75–90%

    4. (d)

      25–30%

  2. 2.

    The Uniform Determination of Death Act (UDDA) defined death as a state of…

    1. (a)

      Irreversible cessation of circulatory and respiratory functions

    2. (b)

      Irreversible cessation of all the functions of the entire brain including the brain stem

    3. (c)

      Irreversible cessation of both cardio-respiratory function and brain functions

    4. (d)

      Either irreversible cessation of circulatory and respiratory functions or irreversible cessation of all levels of brain function including the brain stem

    5. (e)

      Any of the above

  3. 3.

    Symptoms that correlate with the terminal cancer syndrome are except…

    1. (a)

      Anorexia/cachexia in association with increased heart rate

    2. (b)

      Dysphasia

    3. (c)

      Cognitive failure

    4. (d)

      Weight loss

    5. (e)

      The presence of pain

  4. 4.

    Which of the following acts is not protected by the rule of double effect?

    1. (a)

      Do good if you can

    2. (b)

      Do no harm

    3. (c)

      Rationing of health care

    4. (d)

      Physician-assisted suicide

  5. 5.

    Appropriate prescribing of opioids requires all of the following except…

    1. (a)

      Complete medical history

    2. (b)

      Diagnosis of pain generator

    3. (c)

      Documentation of physical examination

    4. (d)

      Documentation of benefit

    5. (e)

      Treatment of side effects

    6. (f)

      Increasing dosing of opioids for terminal sedation is not sanctioned by the rule of double effect

  6. 6.

    Which of the following is not true with respect to do not resuscitate (DNR) orders?

    1. (a)

      DNR orders must be suspended when patients go to have palliative surgery

    2. (b)

      DNR orders are written by physicians after obtaining consent from the patient or assigned patient decision maker

    3. (c)

      DNR orders obtained in the appropriate manner may not be over turned by physicians or family members

    4. (d)

      DNR does not mean “do not treat” or “do nothing”

  7. 7.

    Which of the following is a true statement about CPR?

    1. (a)

      CPR is meant to be used in all circumstances of cardio-pulmonary arrest

    2. (b)

      CPR is successful in more than 70% of cases

    3. (c)

      Patients with end-stage disease who undergo CPR after cardiac arrest have virtually no chance of leaving the hospital and returning home

    4. (d)

      Most patients in long-term nursing care facilities do receive CPR when they have a cardio-pulmonary arrest

  8. 8.

    Which statement is not true relative to the rule of double effect?

    1. (a)

      Providing opioids for pain relief or terminal sedation is permissible as long as the intent is not to hasten death

    2. (b)

      Providing opioids and other sedatives for relief of suffering is permissible even if there is a risk of hastening death as long as death is not the intent of the treatment

    3. (c)

      Providing treatments that can have a bad outcome are permissible as long as the intent of the treatment is to provide the good effect and the patient or authorized designee has consented to undergo the treatment and is aware of the risks

    4. (d)

      Physician-assisted suicide is protected by the rule of double effect

Answers

  1. 1.

    (a)

  2. 2.

    (e)

  3. 3.

    (e)

  4. 4.

    (d)

  5. 5.

    (f)

  6. 6.

    (a)

  7. 7.

    (d)

  8. 8.

    (d)

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Berger, J.M. (2013). Ethics in Palliative and End-of-Life Care. In: Vadivelu, N., Kaye, A., Berger, J. (eds) Essentials of Palliative Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5164-8_27

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  • DOI: https://doi.org/10.1007/978-1-4614-5164-8_27

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  • Online ISBN: 978-1-4614-5164-8

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