Hospice and Palliative Services Research Paper

Excerpt from Research Paper :

Freedom and Moral Responsibility in Hospice and Palliative Services

The different ethical theories

Decision making within the medical field and provision of palliative services is influenced by three ethical theories. The theories are respect for autonomy, beneficence, and non-maleficence. Respect for autonomy asserts that a patient should be allowed the option of decision making. This principle will value the patient's intrinsic worth as an individual allowing them to make a decision that is in their best interest (Holland, 2013). In order for healthcare professionals not to interfere with patient autonomy, they should respect the decisions made and actions taken by the patient. The respect for autonomy will require a doctor to give the patient full information regarding their illness without using jargon. Autonomy is vital for decision making especially for patients with incurable progressive illness, where treatment decisions are unclear and are dependent on the patient's personal values and preferences. Respect for autonomy contrasts with the theory of paternalism. The theory of paternalism looks at a patient as a passive recipient of care.

A patient in a critical condition, is unable to make decisions, and does not have any written wishes for care will lead to the healthcare professionals deciding on the patient's best interests. The decision taken by the healthcare workers might be in contrast to the patient's desires and interests, which raises an ethical dilemma. Using palliative care, the professionals are able to consult and discuss with different caregivers and the family members to come up with an appropriate medical decision. Palliative care would provide the patient with pain relief, and they are likely to recover from their illness.

The theory of beneficence states that healthcare workers should act in a way that will promote the patient's welfare. Therefore, any decisions made regarding a patient should promote their well-being at all stages of their illness (Ross, Capozzi, & Matava, 2012). This principle necessitates the use of palliative and hospice services for patients. The services will offer pain relief, which is essential to the patient and will alleviate any suffering. Andersson et al. (2010) posits that the theory of non-maleficence requires the caregivers to act in such a way that will not cause any injury or harm to the patient. This principle promotes the alleviation of suffering and provision of care at all stages of illness. In a majority of cases, when a patient is nearing the end of time, care is withdrawn, and this causes unnecessary harm and pain to the patient. All actions undertaken are weighed for their good, and any possible harm is identified. Beneficence will ensure that the patient benefits from the care given, and there is a balance of benefits and risks. According to Temel et al. (2010) palliative care is supported by beneficence in that any medical decision is discussed with a team of professionals, which ensures that different views are analyzed before a decision is made. Consultation and discussions with the family members will also ensure that the patient receives the best possible care based on their personal views. When a patient's condition continues to deteriorate, and medical treatment is ineffective this is referred to as futile treatment. Prolonging the life this patient would not be appropriate, but careful evaluation and assessment is vital. This would ensure that the care team is involved in the decision-making. Non-maleficence deems that no futile treatment should be attempted, as this would be regarded as harming the patient. An example is the initiation of CPR on a dying patient.

Difference between ethical theories and emotional constructs

Emotional constructs like intuition and reason are personal expressions that could be affected by a person's mental state. The decisions made when one is emotional might be wrong and lead to severe consequences. Ethical theories require a person to think about any decision they make before they act upon such a decision. Such thinking will ensure that the persona has analyzed both the benefits and risks associated with their decision. Others could support the decision made based on an ethical theory, but an emotional decision is difficult to have any support. Intuition is an ability of a person knowing something, but they do not have any proof regarding what they know or say. In the medical field all decisions are made based on evidence, the use of intuition could result in severe consequences for the patient. Intuition differs from ethical theories in that intuition is acquired unknowingly, but ethical theories have been researched over time and they have backing for their justification.

Ethical theories are well understood, and a person would have to analyze the theories before they react. Emotional constructs require the person to act based on their feelings and emotions. Emotional constructs are based on empathy to the patient, while ethical theories are based on what is best for the patient. Emotions would deny a healthcare professional the ability to perform what is right for the patient. The decision might be critical, but since they are emotionally attached, they are unable to make the correct decision. Ethical theories will first require that the healthcare worker analyses the situation based on the different theories, and then make the right decisions. Using ethical theories, the caregiver will avoid any emotional constructs that might have affected their decision.

Ethics and morals

Ethics and morals relate to wrong and right conduct, but ethics deals with the rules an individual has to follow provided by an external source. Morals refer to the individual's own principles about right and wrong (Murray, 2010). Morals will define personal character, while ethics will stress on a social system where those morals are applied. A healthcare worker is bound by the ethics of the profession, which are the standards and codes that they should follow. Ethics will change based on the situation a person is faced with, but moral code does not change. A doctor knows that killing is wrong, but in the practice of their profession, a patient might die during surgery as a direct result of the doctor. Morally the doctor will feel they wronged the patient, but ethically they are not seen as having done anything wrong. During palliative and hospice care alleviating a patient's pain is the main goal, which might be contrary to a doctor's moral code of treating the illness. The patient would receive quality care while in palliative care since they will not suffer from any pain and they are given medications that alleviate the pain. Moral codes will dictate that they treat the illness, but any attempts to treat the illness results in further pain to the patient.

Free will is the making of decisions without any constraints. Free will is not based on anything and the choices that the individual makes are based on what they deem as right or wrong. Having the ability to act as one pleases, without considering what is wrong and right. Ethics and morals require a person to think of what is right or wrong before they make a decision, but free will does not have such a requirement. When using free will a person does not have any prior causes to consider, they just make the decision. A good example is based on the decision a person might make that they should receive all the necessary care if they become terminally ill. This is a decision made out of free will, but when they become terminally ill, and they are suffering in pain they might rescind on their decision.

Different perspectives of the ethical matter

Current legislation demands that a patient receives all the care they require for their illness. The development of hospice and palliative care centers has allowed the patients to receive medications that will alleviate their pain and suffering. Even if no treatment is available for the illness, pain alleviation allows the patient to recover and gain their strength to fight off the illness. Assisted suicide and euthanasia is only permissible in dire situations. The lack of such options necessitates for the caring of patients until they reach their end of life. The theory or paternalism, which deems a patient to be a recipient of care, fails to consider all aspects of care giving. The failure to listen to a patient's desires could result in legal suits. This theory ignores the fact that a patient has rights like everyone else, and they should receive care based on their personal or religious views. The theory of paternalism would not consider a Jehovah witness patient and a doctor who follows this theory would go ahead and administer blood transfusion. This would go against the patient's religious beliefs, but the doctor would have done the transfusion based on the theory they follow. The doctor would be following the theory of beneficence and non-maleficence, which require that they make decisions that would offer the best care to the patient and does not harm the patient.


Research has shown that in Netherlands where euthanasia is legalized there are few palliative centers as compared to…

Sources Used in Document:


Andersson, G.B., Chapman, J.R., Dekutoski, M.B., Dettori, J., Fehlings, M.G., Fourney, D.R., . . . Weinstein, J.N. (2010). Do no harm: the balance of "beneficence" and "non-maleficence." Spine, 35(9S), S2-S8.

Holland, S. (2013). Arguing About Bioethics. Abingdon, Oxon OX14 4SB: Taylor & Francis.

Murray, J.S. (2010). Moral Courage in Healthcare: Acting Ethically Even in the Presence of Risk. Online Journal of Issues in Nursing, 15(3).

Ross, J.R., Capozzi, J.D., & Matava, M.J. (2012). Discussing treatment options with a minor: The conflicts related to autonomy, beneficence, and paternalism. The Journal of Bone & Joint Surgery, 94(1), e3 1-4.

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