Ethical Analysis – Looking Into Palliative Care Strategy

Ethical Analysis -- Strategy for Palliative Care

The sector for healthcare has, in the last 50 years, improved in its efforts towards cost minimization and service delivery enhancement. Some elements of improvement (such as automation) ensued from technological advances. However, other elements (such as strategy application) owe their establishment in the health sector to endeavors on the part of intelligent, like-minded people who understand life's worth, and that of minimal suffering when it comes to illness. Palliative care represents one such effort. It denotes a system targeted at delivering respite from painful, disturbing symptoms through the affirmation of life and considering death to be a process. Palliative care, as defined by the World Health Organization, is an approach, which enhances quality of life (QOL) of patients, suffering from life-threatening ailments, and their family via prevention and symptom relief. This, they achieve through early diagnosis, and proper assessment and pain treatment, as well as spiritual, physical, and psychological care. Though there are structures instituted for the purpose of palliative care, developing efficient strategies for propelling the health sector along the right path is of utmost importance. This is where a majority of palliative care facilities are found lacking. This paper's objective is to deal with the subject of strategizing for facilitating palliative care delivery (Policy Directive, 2010).

Application of External Ethical Standards

Usually, ethical problems crop up in the palliative care setting due to concerns regarding the type and amount of care appropriate for individuals having short life expectancy. A conflict normally exists among physicians, nurses, other members of the care delivery team, patients, and their family, with regard to what forms appropriate care, especially as terminally-ill patients approach their deathbed. Recently, the value of ethically-grounded medical practice is garnering increasing emphasis. Numerous countries and groups have demanded a widely-accepted, elementary ethics curriculum for healthcare providers. The many morals and ethical codes outlined in different declarations and oaths are the foundation for ethical healthcare practices. One such oath, widely taken since several hundred years by new graduates in medicine, is the 'Hippocratic Oath'. In spite of the differences found among different historical documents, there are many common ethical doctrines or value orientations highlighted among them; these include: kindness, justice, non-maleficence, and regard for patients' confidentiality and autonomy. Will this revival, in significance of ethics in the medical field, benefit patients alone? This paper will examine research indicating that healthcare experts, including physicians, experience increased stress when they feel the healthcare body they are linked to does not share their ethical values or standards. Patients as well as healthcare providers will profit from focusing on ethical clinical practice and the negotiation skills. The above aspects are vital and have to be taken into account when deciding upon a strategy for palliative care organizations (Gabel, 2010).

Palliative Care Strategy

The strategy intends to establish an organized, informed practice approach for palliative care delivery and ethics. The main goals in development of this strategy are as follows:

Formulation of a realistic, dependable strategy that reinforces existing structures, including providing quality palliative care services by organizations, such as hospitals, hospices, charitable organizations, home support organizations, and elder care facilities.

Development of a more receptive system that supervises nurses' as well as physicians' ethical assessment.

Promotion of awareness regarding the value of maintaining high standards of ethics and professionalism throughout practice.

Incorporation of other stakeholders (e.g., local and federal governmental bodies) governing palliative care practices.

Consistent with the above goals, the strategy mandates further that any person acting/working for partners must immediately bring to the attention of authorities any external or internal issue violating the ethical standards of palliative care. This mandate and duty to report represents a responsibility as well as a right for all professionals in the health sector. Aside from grassroots-level ethical standards, support of palliative care delivery at the government's highest levels is essential, as is establishment of structures for operational and strategic delivery of effective services. At the level of governmental policy, the strategy must be overseen by a high-ranking health department officer. This officer (recommended highly to be an expert in the healthcare arena) must be entrusted the overall duty of formulating a budget for palliative care, in addition to ethical policies, before introducing commissioning. Further, the strategy includes the creation of mechanisms and common guidelines and policy frameworks with regard to handling unethical behaviors in clinical settings and resultant penalty to be meted out. As the clinical care committee and governments integrate with this regard, the responsibility of handling unethical practices must be assigned to an objective, independent body for avoiding bias (Chambers, 2015).

Integrating Decision Making Process

Usually, ethical problems crop up in the palliative care setting due to concerns regarding the type and amount of care appropriate for individuals having short life expectancy. A conflict normally exists among physicians, nurses, other members of the care delivery team, patients, and their family, with regard to what forms appropriate care, especially as terminally-ill patients approach their deathbed. The aforementioned parties must be allowed to participate in making decisions regarding all palliative care aspects, right from policy development to practical care. Ensuring the presence of appropriate channels of communication among decision makers is extremely important, as these channels allow free information flow along the decision making hierarchy (i.e., from bottom to top). One must, however, always expect gaps to arise in these settings. This occurs more commonly in the decision-making phase of Advance Care Planning. This is a continuous process wherein patients, their caregivers/families, and physicians/nurses consider patient values, beliefs, and goals, deliberate over how present and future patient care must be informed, and finally, apply this information for correctly documenting future choices in health care, preferably following an assessment of caregiver's and patient's hopes, fears, needs, and knowledge. While planning, unified decisions are required of patients (if they are right-minded), nurses, physicians, and caregivers. But a common practice seen is coercion by highest-ranking decision-makers (doctors, in the healthcare context), who ultimately end up making all decisions for other participating persons. Nurses as well as physicians argue from a medical perspective, whereas patients and their caregivers argue from an opposing stance along familial and social lines that always involve sympathy. Social and scientific values always differ. While attempting to resolve such an issue, formulation of legal standards, in association with decision making as well as who possesses the ultimate right, on the government's part is pivotal. This must be carried out according to human rights directives. Moreover, practicing of superior ethical conduct by all involved persons, particularly healthcare professionals (i.e., nurses and physicians) is utterly crucial. This may be achieved through the development of rules governing healthcare professionals in such instances (Fromme, Smith, 2015).

Achieving Consensus within the Decision Making Group