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Ethical Considerations in Palliative Care

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Palliative Care in Hematologic Malignancies and Serious Blood Disorders

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Abstract

In this chapter, we discuss the ethical features of palliative care for patients with hematologic malignancies and serious blood disorders. The goal of this chapter is to offer tools for clinicians to analyze ethical challenges in palliative care practice in order to provide optimal care to patients, families, and society at large. We begin by describing several common methods of ethical analysis and frameworks for that analysis, particularly as these relate to the palliative care setting. Subsequently, we provide an overview of some of the unique ethical considerations relating to palliative care for patients with hematologic malignancies and serious blood disorders, including ethical issues surrounding uncertainty, the ethics of healthcare decision-making and symptom management, special considerations regarding withholding or withdrawing/discontinuing treatments, and ethical issues related to medical aid-in-dying. We also briefly explore unique ethical considerations with vulnerable populations and in palliative care research. Lastly, we describe the ethical complexities of provider moral distress and conscience-based objections in the palliative care setting. Throughout, we provide representative clinical scenarios with challenging questions to further reinforce these complex issues.

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Notes

  1. 1.

    The phrasing “ordinary” versus “extraordinary” is important here, as this distinction has been made in Catholic teachings, which do not obligate “extraordinary means of preserving life” (see reference 63: Ball H. The right to die: a reference handbook. Santa Barbara, California: ABC-CLIO; 2017) and was cited in the official ruling in the case of Karen Ann Quinlan (see reference 51: In Re Quinlan, 355 A.2d 647 (1976)).

References

  1. National Cancer Institute. Palliative care in cancer. Last updated 20 Oct 2017. Last viewed 07 Jul 2020. https://www.cancer.gov/about-cancer/advanced-cancer/care-choices/palliative-care-fact-sheet.

  2. Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, et al. Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017;35(1):96–112.

    Article  PubMed  Google Scholar 

  3. National Coalition for Hospice and Palliative Care. Clinical practice guidelines for quality palliative care. 4th ed. Richmond, VA: National Coalition for Hospice and Palliative Care; 2018.

    Google Scholar 

  4. Beauchamp TL, Childress JF. Principles of biomedical ethics. 6th ed. New York: Oxford University Press; 2009.

    Google Scholar 

  5. Jonsen AR, Toulmin S. The abuse of casuistry: a history of moral reasoning. Berkeley: University of California Press; 1988.

    Google Scholar 

  6. Donovan GK, Pellegrino ED. Virtues and goals in pediatrics. In: Miller G, editor. Pediatric bioethics. London, England: Cambridge University Press; 2009.

    Google Scholar 

  7. Charon R, Montello M. Stories matter : the role of narrative in medical ethics. New York: Routledge; 2002.

    Google Scholar 

  8. Montello M. Narrative ethics. Hast Cent Rep. 2014;44(1 Suppl):S2–6.

    Google Scholar 

  9. Jaggar AM. Feminist ethics. In: The Blackwell guide to ethical theory; 2013. p. 433–60.

    Google Scholar 

  10. Jonsen AR, Siegler M, Winslade WJ. Clinical ethics: a practical approach to ethical decisions in clinical medicine. Eighth edition. ed. New York: McGraw-Hill Education; 2015.

    Google Scholar 

  11. National Center for ethics in health care. Ethics consultation: responding to ethics questions in health care. Last viewed 26 Jun 2020. https://www.ethics.va.gov/ECprimer.pdf.

  12. Grace PJ. Nursing ethics and professional responsibility in advanced practice. Third edition. ed. Burlington, Massachusetts: Jones & Bartlett Learning; 2018.

    Google Scholar 

  13. O'Brien JM Jr, Aberegg SK, Ali NA, Diette GB, Lemeshow S. Results from the national sepsis practice survey: predictions about mortality and morbidity and recommendations for limitation of care orders. Crit Care. 2009;13(3):R96.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Curtis JR, Park DR, Krone MR, Pearlman RA. Use of the medical futility rationale in do-not-attempt-resuscitation orders. JAMA. 1995;273(2):124–8.

    Article  CAS  PubMed  Google Scholar 

  15. Novack DH, Plumer R, Smith RL, Ochitill H, Morrow GR, Bennett JM. Changes in physicians' attitudes toward telling the cancer patient. JAMA. 1979;241(9):897–900.

    Article  CAS  PubMed  Google Scholar 

  16. The AM, Hak T, Koëter G, van der Wal G. Collusion in doctor-patient communication about imminent death: an ethnographic study. West J Med. 2001;174(4):247–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Lamont EB, Christakis NA. Prognostic disclosure to patients with cancer near the end of life. Ann Intern Med. 2001;134(12):1096–105.

    Article  CAS  PubMed  Google Scholar 

  18. Enzinger AC, Zhang B, Schrag D, Prigerson HG. Outcomes of prognostic disclosure: associations with prognostic understanding, distress, and relationship with physician among patients with advanced cancer. J Clin Oncol. 2015;33(32):3809–16.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Marron JM, Cronin AM, Kang TI, Mack JW. Intended and unintended consequences: ethics, communication, and prognostic disclosure in pediatric oncology. Cancer. 2018;124(6):1232–41.

    Article  PubMed  Google Scholar 

  20. Chhabra KR, Pollak KI, Lee SJ, Back AL, Goldman RE, Tulsky JA. Physician communication styles in initial consultations for hematological cancer. Patient Educ Couns. 2013;93(3):573–8.

    Article  PubMed  Google Scholar 

  21. Smith AK, White DB, Arnold RM. Uncertainty — The other side of prognosis. N Engl J Med. 2013;368(26):2448–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5(4):302–11.

    Article  CAS  PubMed  Google Scholar 

  23. Kissane DW, Bultz BD, Butow PN, Noble S, Wilkinson S. Oxford textbook of communication in oncology and palliative care. Oxford University Press; 2017.

    Book  Google Scholar 

  24. LeBlanc TW, Marron JM, Ganai S, McGinnis MM, Spence RA, Tenner L, et al. Prognostication and communication in oncology. J Oncol Pract. 2019;15(4):208–15.

    Article  PubMed  Google Scholar 

  25. Jackson VA, Jacobsen J, Greer JA, Pirl WF, Temel JS, Back AL. The cultivation of prognostic awareness through the provision of early palliative care in the ambulatory setting: a communication guide. J Palliat Med. 2013;16(8):894–900.

    Article  PubMed  Google Scholar 

  26. Temel JS, Shaw AT, Greer JA. Challenge of prognostic uncertainty in the modern era of cancer therapeutics. J Clin Oncol. 2016;34(30):3605–8.

    Article  PubMed  Google Scholar 

  27. LeBlanc TW, Temel JS, Helft PR. “How much time do I have?”: communicating prognosis in the era of exceptional responders. Am Soc Clin Oncol Educ Book. 2018;38:787–94.

    Article  PubMed  Google Scholar 

  28. Appelbaum PS. Clinical practice. Assessment of patients' competence to consent to treatment. N Engl J Med. 2007;357(18):1834–40.

    Article  CAS  PubMed  Google Scholar 

  29. Drane JF. Competency to give an informed consent. A model for making clinical assessments. JAMA. 1984;252(7):925–7.

    Article  CAS  PubMed  Google Scholar 

  30. Marron JM, Kyi K, Appelbaum PS, Magnuson A. Medical decision-making in oncology for patients lacking capacity. Am Soc Clin Oncol Educ Book. 2020;40:e186–e96.

    Article  Google Scholar 

  31. Katz AL, Webb SA, Committee on Bioethics. Informed consent in decision-making in pediatric practice. Pediatrics. 2016;138(2):e20161485.

    Article  PubMed  Google Scholar 

  32. DeMartino ES, Dudzinski DM, Doyle CK, Sperry BP, Gregory SE, Siegler M, et al. Who decides when a patient Can't? Statutes on alternate decision makers. N Engl J Med. 2017;376(15):1478–82.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Buchanan AE, Brock DW. Deciding for others: the ethics of surrogate decision making. Cambridge England; New York: Cambridge University Press; 1989.

    Google Scholar 

  34. Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012;27(10):1361–7.

    Article  PubMed  PubMed Central  Google Scholar 

  35. American Medical Association. Council on ethical and judicial affairs. Code of medical ethics of the American Medical Association. Chicago: American Medical Association; 2017.

    Google Scholar 

  36. Burns JP, Truog RD. Futility: a concept in evolution. Chest. 2007;132(6):1987–93.

    Article  PubMed  Google Scholar 

  37. Nuffield Council on Bioethics. Dementia: ethical issues 2009. Published 01 Oct 2009. Last viewed 07 Jul 2020. https://www.nuffieldbioethics.org/publications/dementia.

  38. Bosslet GT, Pope TM, Rubenfeld GD, Lo B, Truog RD, Rushton CH, et al. An official ATS/AACN/ACCP/ESICM/SCCM policy statement: responding to requests for potentially inappropriate treatments in intensive care units. Am J Respir Crit Care Med. 2015;191(11):1318–30.

    Article  PubMed  Google Scholar 

  39. Kon AA, Shepard EK, Sederstrom NO, Swoboda SM, Marshall MF, Birriel B, et al. Defining futile and potentially inappropriate interventions: a policy statement from the Society of Critical Care Medicine ethics Committee. Crit Care Med. 2016;44(9):1769–74.

    Article  PubMed  Google Scholar 

  40. Marron JM, Jones E, Wolfe J. Is there ever a role for the unilateral do not attempt resuscitation order in pediatric care? J Pain Symptom Manag. 2018;55(1):164–71.

    Article  Google Scholar 

  41. Biegler P. Should patient consent be required to write a do not resuscitate order? J Med Ethics. 2003;29(6):359–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Courtwright AM, Brackett S, Cadge W, Krakauer EL, Robinson EM. Experience with a hospital policy on not offering cardiopulmonary resuscitation when believed more harmful than beneficial. J Crit Care. 2015;30(1):173–7.

    Article  PubMed  Google Scholar 

  43. Blinderman CD. Do surrogates have a right to refuse pain medications for incompetent patients? J Pain Symptom Manag. 2012;43(2):299–305.

    Article  Google Scholar 

  44. Moreno-Galvan A, Marron JM, Marsiglio AM. How should we approach parental refusals of opioids on behalf of children in the perioperative setting? A practical approach based on ethical theory. Paediatr Anaesth. 2020;30:852.

    Article  PubMed  Google Scholar 

  45. Olsen ML, Swetz KM, Mueller PS. Ethical decision making with end-of-life care: palliative sedation and withholding or withdrawing life-sustaining treatments. Mayo Clin Proc. 2010;85(10):949–54.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Quill TE, Dresser R, Brock DW. The rule of double effect—a critique of its role in end-of-life decision making. N Engl J Med. 1997;337(24):1768–71.

    Article  CAS  PubMed  Google Scholar 

  47. McIntyre A. Doctrine of double effect. In: Zalta EN, ed. The Stanford encyclopedia of philosophy. Last updated 24 Dec 2018. Last viewed 07 Jul 2020. https://plato.stanford.edu/entries/double-effect/.

  48. Vacco v. Quill. United States Supreme Court; 1997.

    Google Scholar 

  49. Mercadante S, Porzio G, Valle A, Fusco F, Aielli F, Costanzo V. Palliative sedation in patients with advanced cancer followed at home: a systematic review. J Pain Symptom Manag. 2011;41(4):754–60.

    Article  Google Scholar 

  50. Fine RL. Language matters: "sometimes we withdraw treatment but we never withdraw care". J Palliat Med. 2007;10(6):1239–40.

    Article  PubMed  Google Scholar 

  51. In Re Quinlan, 355 A.2d 647, 1976.

    Google Scholar 

  52. Cruzan v Director, Missouri Department of Health, 497 US, 110 S. Ct, 2841,1990.

    Google Scholar 

  53. Omnibus Budget Reconciliation Act of 1990, 1991.

    Google Scholar 

  54. Fried TR, O'Leary J, Van Ness P, Fraenkel L. Inconsistency over time in the preferences of older persons with advanced illness for life-sustaining treatment. J Am Geriatr Soc. 2007;55(7):1007–14.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Patrick DL, Pearlman RA, Starks HE, Cain KC, Cole WG, Uhlmann RF. Validation of preferences for life-sustaining treatment: implications for advance care planning. Ann Intern Med. 1997;127(7):509–17.

    Article  CAS  PubMed  Google Scholar 

  56. Meier DE, Beresford L. POLST offers next stage in honoring patient preferences. J Palliat Med. 2009;12(4):291–5.

    Article  PubMed  Google Scholar 

  57. National POLST. POLST. National POLST Paradigm. Last updated 2020. Last viewed 07 Jul 2020. https://polst.org/.

  58. Brock DW. Death and dying. In: Veatch R, editor. Medical ethics. 2nd ed. Sudbury, MA: Jones and Bartlett Publishers; 1997.

    Google Scholar 

  59. Wilkinson D, Butcherine E, Savulescu J. Withdrawal aversion and the equivalence test. Am J Bioeth. 2019;19(3):21–8.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Chung GS, Yoon JD, Rasinski KA, Curlin FA. US Physicians' opinions about distinctions between withdrawing and withholding life-sustaining treatment. J Relig Health. 2016;55(5):1596–606.

    Article  PubMed  Google Scholar 

  61. Sulmasy DP, Sugarman J. Are withholding and withdrawing therapy always morally equivalent? J Med Ethics. 1994;20(4):218–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. President’s Commission for the Study of ethical problems in medicine and biomedical and behavioral research. Deciding to forego life-sustaining treatment: a report on the ethical, medical, and legal issues in treatment decisions. Washington, DC: US Government Printing Office; 1983.

    Google Scholar 

  63. Ball H. The right to die: a reference handbook. Santa Barbara, California: ABC-CLIO, LLC; 2017.

    Google Scholar 

  64. American Academy of hospice and palliative medicine. Statement on artificial nutrition and hydration near the end of life. Last updated 13 Sep 2013. Last viewed 07 Jul 2020. http://aahpm.org/positions/anh.

  65. ANA Center for Ethics and Human Rights. position statement: nutrition and hydration at the end of life silver springs, MD. Last updated 2017. Last viewed 07 Jul 2020. https://www.nursingworld.org/~4af0ed/globalassets/docs/ana/ethics/ps_nutrition-and-hydration-at-the-end-of-life_2017june7.pdf.

  66. Diekema DS, Botkin JR. Forgoing medically provided nutrition and hydration in children. Pediatrics. 2009;124(2):813.

    Article  PubMed  Google Scholar 

  67. Rubin EB, Bernat JL. Voluntarily stopping eating and drinking. In: Quill TE, Miller FT, editors. Palliative care and ethics. New York, NY: Oxford University Press; 2014.

    Google Scholar 

  68. Dugdale LS, Lerner BH, Callahan D. Pros and cons of physician aid in dying. Yale J Biol Med. 2019;92(4):747–50.

    PubMed  PubMed Central  Google Scholar 

  69. O'Rourke MA, O'Rourke MC, Hudson MF. Reasons to reject physician assisted suicide/physician aid in dying. J Oncol Pract. 2017;13(10):683–6.

    Article  PubMed  Google Scholar 

  70. Dees M, Vernooij-Dassen M, Dekkers W, van Weel C. Unbearable suffering of patients with a request for euthanasia or physician-assisted suicide: an integrative review. Psychooncology. 2010;19(4):339–52.

    Article  PubMed  Google Scholar 

  71. Sjostrand M, Helgesson G, Eriksson S, Juth N. Autonomy-based arguments against physician-assisted suicide and euthanasia: a critique. Med Health Care Philos. 2013;16(2):225–30.

    Article  PubMed  Google Scholar 

  72. Materstvedt LJ. Palliative care on the 'slippery slope' towards euthanasia? Palliat Med. 2003;17(5):387–92.

    Article  PubMed  Google Scholar 

  73. Death with Dignity. Religion and Spirituality. 2020. https://www.deathwithdignity.org/learn/religion-spirituality/.

  74. Gopal AA. Physician-assisted suicide: considering the evidence, existential distress, and an emerging role for psychiatry. J Am Acad Psychiatry Law. 2015;43(2):183–90.

    PubMed  Google Scholar 

  75. Olsen DP, Chan R, Lehto R. Ethical nursing care when the terminally ill patient seeks death. Am J Nurs. 2017;117(7):50–5.

    Article  PubMed  Google Scholar 

  76. Sulmasy DP, Finlay I, Fitzgerald F, Foley K, Payne R, Siegler M. Physician-assisted suicide: why neutrality by organized medicine is neither neutral nor appropriate. J Gen Intern Med. 2018;33(8):1394–9.

    Article  PubMed  PubMed Central  Google Scholar 

  77. ANA Center for Ethics and Human Rights. ANA position statement: The Nurse’s role when a patient requests medical aid in dying. Online J Issues Nurs. 2019;24(3)

    Google Scholar 

  78. Frieden J. Physician-assisted suicide once again divides AMA members: MedPage today. Last updated 11 Jun 2019. 2020. https://www.medpagetoday.com/meetingcoverage/ama/80384.

  79. American Medical Association. Physician-assisted suicide. Last updated 14 Nov 2016. Last viewed 26 Jun 2020. https://www.ama-assn.org/delivering-care/ethics/physician-assisted-suicide.

  80. Position statement on physician-assisted death. J Pain Palliat Care Pharmacother. 2007;21(4):55–7.

    Article  Google Scholar 

  81. CNN Editorial research. Physician-assisted suicide fast facts: CNN. Last updated 11 Jun 2020. Last viewed 07 Jul 2020. https://www.cnn.com/2014/11/26/us/physician-assisted-suicide-fast-facts/index.html.

  82. Law T. Colorado doctor fired after suing to provide patient with aid-in-dying medication: time. Last updated 03 Sep 2019. Last viewed 26 Jun 2020. https://time.com/5666225/colorado-doctor-fired-after-suing-to-provide-patient-with-aid-in-dying-medication/.

  83. Aleccia J. Terminally ill, he wanted aid-in-dying. His Catholic hospital said no. Kaiser Health News. Last updated 29 Jan 2020. Last viewed 26 Jun 2020. https://khn.org/news/when-aid-in-dying-is-legal-but-the-medicine-is-out-of-reach/.

  84. National Center on Birth Defects and Developmental Disabilities. Disability impacts all of us. Centers for Disease Control and Prevention. Last updated 09 Sep 2019. Last viewed 26 Jun 2020. https://www.cdc.gov/ncbddd/disabilityandhealth/infographic-disability-impacts-all.html.

  85. Mitchell SE, Weigel GM, Stewart SK, Mako M, Loughnane JF. Experiences and perspectives on advance care planning among individuals living with serious physical disabilities. J Palliat Med. 2017;20(2):127–33.

    Article  PubMed  Google Scholar 

  86. Voss H, Vogel A, Wagemans AMA, Francke AL, Metsemakers JFM, Courtens AM, et al. Advance care planning in palliative care for people with intellectual disabilities: a systematic review. J Pain Symptom Manag. 2017;54(6):938–60 e1.

    Article  Google Scholar 

  87. Read S. Palliative care for people with intellectual disabilities: pitfalls and potential. Palliat Med. 2013;27(1):3–4.

    Article  PubMed  Google Scholar 

  88. Dunkley S, Sales R. The challenges of providing palliative care for people with intellectual disabilities: a literature review. Int J Palliat Nurs. 2014;20(6):279–84.

    Article  PubMed  Google Scholar 

  89. Iezzoni LI, Rao SR, Ressalam J, Bolcic-Jankovic D, Agaronnik ND, Donelan K, et al. Physicians' perceptions of people with disability and their health care. Health Aff (Millwood). 2021;40(2):297–306.

    Article  PubMed  Google Scholar 

  90. Albrecht GL, Devlieger PJ. The disability paradox: high quality of life against all odds. Soc Sci Med. 1999;48(8):977–88.

    Article  CAS  PubMed  Google Scholar 

  91. Smith AK, Ritchie CS, Wallhagen ML. Hearing loss in hospice and palliative care: a National Survey of providers. J Pain Symptom Manag. 2016;52(2):254–8.

    Article  Google Scholar 

  92. den Boer K, de Veer AJE, Schoonmade LJ, Verhaegh KJ, van Meijel B, Francke AL. A systematic review of palliative care tools and interventions for people with severe mental illness. BMC Psychiatry. 2019;19(1):106.

    Article  Google Scholar 

  93. Kozlov E, Niknejad B, Reid MC. Palliative care gaps in providing psychological treatment: a review of the current state of research in multidisciplinary palliative care. Am J Hosp Palliat Care. 2018;35(3):505–10.

    Article  PubMed  Google Scholar 

  94. Farrell TW, Widera E, Rosenberg L, Rubin CD, Naik AD, Braun U, et al. AGS position statement: making medical treatment decisions for Unbefriended older adults. J Am Geriatr Soc. 2017;65(1):14–5.

    Article  PubMed  Google Scholar 

  95. Effiong A, Harman S. Patients who lack capacity and lack surrogates: can they enroll in hospice? J Pain Symptom Manag. 2014;48(4):745–50 e1.

    Article  Google Scholar 

  96. Pope TM, Bennett J, Carson SS, Cederquist L, Cohen AB, DeMartino ES, et al. Making medical treatment decisions for unrepresented patients in the ICU. An official American Thoracic Society/American Geriatrics Society policy statement. Am J Respir Crit Care Med. 2020;201(10):1182–92.

    Article  PubMed  PubMed Central  Google Scholar 

  97. Connor DM, Elkin GD, Lee K, Thompson V, Whelan H. The Unbefriended patient: an exercise in ethical clinical reasoning. J Gen Intern Med. 2016;31(1):128–32.

    Article  PubMed  Google Scholar 

  98. Chamberlain S, Baik S, Estabrooks C. Going it alone: a scoping review of Unbefriended older adults. Can J Aging. 2018;37(1):1–11.

    Article  PubMed  PubMed Central  Google Scholar 

  99. American Academy of Pediatrics. Committee on bioethics and Committee on hospital care. Palliative care for children. Pediatrics. 2000;106(2 Pt 1):351–7.

    Google Scholar 

  100. Hellsten MB, Berg S. Symptom management in paediatric palliative care. In: Ferrell BR, Coyle N, Paice J, editors. Oxford textbook of palliative nursing. 3rd ed. Oxford: Oxford University Press; 2010.

    Google Scholar 

  101. Paul SR. Child welfare vs. parental religious views. AAP News. 2011;32(5):20.

    Google Scholar 

  102. Religious Objections to Medical Care. Pediatrics. 1997;99(2):279.

    Article  Google Scholar 

  103. Prince v. Massachusetts, 321 US 158, 1944.

    Google Scholar 

  104. Woolley S. Children of Jehovah's witnesses and adolescent Jehovah's witnesses: what are their rights? Arch Dis Child. 2005;90(7):715–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  105. Morrison v. State, 252 S.W.2d 97. Kansas City Court of Appeals, Missouri, 1952.

    Google Scholar 

  106. Ukachi N, Morrison W, Vanhorn S, Sundaram R, Lantos JD. A young adult Jehovah's witness with severe anemia. Pediatrics. 2013;132(3):547–51.

    Article  PubMed  Google Scholar 

  107. Lyerly AD. Statutory restrictions on advance care planning and pregnancy. JAMA. 2019;321(16):1574–5.

    Article  PubMed  Google Scholar 

  108. Turner M. Editorial. Palliat Med. 2018;32(1):4–5.

    Article  PubMed  Google Scholar 

  109. Pazart L, Godard-Marceau A, Chassagne A, Vivot-Pugin A, Cretin E, Amzallag E, et al. Prevalence and characteristics of prisoners requiring end-of-life care: a prospective national survey. Palliat Med. 2018;32(1):6–16.

    Article  PubMed  Google Scholar 

  110. Rothman A, McConville S, Hsia R, Metzger L, Ahalt C, Williams BA. Differences between incarcerated and non-incarcerated patients who die in community hospitals highlight the need for palliative care services for seriously ill prisoners in correctional facilities and in community hospitals: a cross-sectional study. Palliat Med. 2018;32(1):17–22.

    Article  PubMed  Google Scholar 

  111. Jameton A. Nursing practice : the ethical issues. Englewood Cliffs, N.J: Prentice-Hall; 1984.

    Google Scholar 

  112. Epstein EG, Hamric AB. Moral distress, moral residue, and the crescendo effect. J Clin Ethics. 2009;20(4):330–42.

    Article  PubMed  Google Scholar 

  113. Wicclair MR. Conscientious objection in health care: an ethical analysis. Cambridge: Cambridge University Press; 2011.

    Book  Google Scholar 

  114. Rushton CH, Caldwell M, Kurtz M. CE: moral distress: a catalyst in building moral resilience. Am J Nurs. 2016;116(7):40–9.

    Article  PubMed  Google Scholar 

  115. American Nurses Association. Code of ethics for nurses with interpretive statements. 2nd ed. Silver Spring, MD: American Nurses Association; 2015.

    Google Scholar 

  116. Sulmasy DP. Conscience, tolerance, and pluralism in health care. Theor Med Bioeth. 2019;40(6):507–21.

    Article  PubMed  Google Scholar 

  117. Giubilini A. Conscientious objection in healthcare: neither a negative nor a positive right. J Clin Ethics. 2020;31(2):146–53.

    Article  PubMed  Google Scholar 

  118. Emanuel EJ. The Oxford textbook of clinical research ethics. Oxford; New York: Oxford University Press; 2008.

    Book  Google Scholar 

  119. Henderson GE, Churchill LR, Davis AM, Easter MM, Grady C, Joffe S, et al. Clinical trials and medical care: defining the therapeutic misconception. PLoS Med. 2007;4(11):e324.

    Article  PubMed  PubMed Central  Google Scholar 

  120. Williams MA, Haywood C Jr. Critical care research on patients with advance directives or do-not-resuscitate status: ethical challenges for clinician-investigators. Crit Care Med. 2003;31(3 Suppl):S167–71.

    Article  PubMed  Google Scholar 

  121. Emanuel EJ, Wendler D, Grady C. What makes clinical research ethical? JAMA. 2000;283(20):2701–11.

    Article  CAS  PubMed  Google Scholar 

  122. Casarett DJ, Knebel A, Helmers K. Ethical challenges of palliative care research. J Pain Symptom Manag. 2003;25(4):S3–5.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Oncology, Dana-Farber Cancer Institute and the Harvard Medical School Center for Bioethics, Boston, MA, USA

    Jonathan M. Marron

  2. Boston College Connell School of Nursing, Chestnut Hill, MA, USA

    Melissa K. Uveges

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Correspondence to Jonathan M. Marron .

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  1. Harvard Medical School, Boston, MA, USA

    Christina K. Ullrich

  2. Oregon Health and Science University, Portland, OR, USA

    Eric J. Roeland

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Marron, J.M., Uveges, M.K. (2023). Ethical Considerations in Palliative Care. In: Ullrich, C.K., Roeland, E.J. (eds) Palliative Care in Hematologic Malignancies and Serious Blood Disorders. Springer, Cham. https://doi.org/10.1007/978-3-031-38058-7_18

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