Planning and providing care for a person with a life-limiting illness can involve ethically complex decision-making. This can occur at any point along the illness trajectory. It is important for all healthcare providers to understand potential ethical dilemmas. Treatment decisions can challenge your values and beliefs. This can:
- Influence the care you provide or recommend
- Cause tension between
- the person with a life-limiting illness
- their family/carers
- healthcare providers.
Examples of complex ethical issues encountered in palliative care include:
- Determining the method and timing of conversations with family members around the imminent death of a loved one
- Deciding when to withdraw treatment that is considered medically futile
- Use of artificial nutrition and hydration
- Use of palliative sedation
- Requests for assistance to die
- Requests for autopsy.
Four basic principles of biomedical ethics are autonomy (self-determination), justice, beneficence (doing good), and non-maleficence (doing no harm). For practice to be considered ‘ethical’ it must respect all four of these principles. Application of these principles assists in decision-making regarding issues such as informed consent, truth telling, confidentiality and respect.
End- of-Life Law Resources
End of Life Law in Australia resources provide accurate, practical and relevant information to assist clinicians navigate the challenging legal issues that can arise with end of life decision-making. Information is presented about Australian laws relating to death, dying and decision-making at the end of life. These laws are very complex, particularly in Australia, where the law differs between states and territories, and where areas of uncertainty about the law exist.
Clinicians can enhance their understanding of these laws and knowledge about legal rights and responsibilities at end-of-life. Key topics include:
- Capacity and consent to medical treatment
- Advance Directives
- Stopping treatment
- Withholding and withdrawing life-sustaining treatment from adults
- Substitute decision making for adults
- Futile or non-beneficial treatment
- Emergency medical treatment in each state and territory
- Children and end-of-life decision-making
- Guardianship law
- Complaints and dispute resolution
- Palliative medication
- Organ donation
- Voluntary assisted dying.
- Refer to the ethical guidelines / code of conduct relevant to your discipline and answer the following questions:
- How would you respond in a situation where a caregiver has asked you not to inform the person with a life-limiting illness about their diagnosis?
- How do you respond to a person who tells you that they have ‘had enough’ and no longer want treatment?
- How would you respond if someone requests that you help them end their life early?
- Search recent literature and identify definitions of the term ‘futile treatment’ and ‘non-beneficial’ treatment.
- In what ways can perceptions of futility differ between the person with a life-limiting illness, families and carers and health professionals, and between different health professionals?
- Refer to the Euthanasia and Assisted Dying page from QUT End of Life Law in Australia. Consider how the Victorian Voluntary Assisted Dying Law affects the provision of palliative care.
- Palliative Care Expert Group, Therapeutic Guidelines: palliative care. 4 ed. 2016, Melbourne: Therapeutic Guidelines Limited.
- Beauchamp, T.L. and J.F. Childress, Principles of Biomedical Ethics. 2012, New York: Oxford University Press.