Ethics and Moral Responsibility in Hospice and Palliative Care

Introduction to Ethical Theories in Palliative Care

Decision-making within the medical field and the provision of palliative services is influenced by three ethical theories: respect for autonomy, beneficence, and non-maleficence. Respect for autonomy asserts that a patient should be allowed the option of making their own decisions. This principle values the patient's intrinsic worth as an individual, allowing them to make decisions that are in their best interest (Holland, 2013). In order for healthcare professionals not to interfere with patient autonomy, they should respect the decisions and actions taken by the patient. Respect for autonomy also requires 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 depend on the patient's personal values and preferences. Respect for autonomy contrasts with the theory of paternalism, which views a patient as a passive recipient of care.

When a patient in a critical condition is unable to make decisions and has no written wishes for care, healthcare professionals must decide in the patient's best interests. The decision taken by healthcare workers might contrast with the patient's own desires and interests, raising an ethical dilemma. Using palliative care, professionals are able to consult and discuss with different caregivers and family members to arrive at an appropriate medical decision. Palliative care can provide the patient with pain relief, supporting their ability to cope with their illness.

The theory of beneficence states that healthcare workers should act in a way that promotes 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, as these services offer pain relief that is essential to the patient and alleviates suffering. Andersson et al. (2010) posit that the theory of non-maleficence requires 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 the provision of care at all stages of illness. In many cases, when a patient is nearing the end of life, care is withdrawn, causing unnecessary harm and pain. All actions undertaken should be weighed for their benefit, and any possible harm should be identified.

Beneficence ensures that the patient benefits from the care given and that 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, ensuring that different perspectives are analyzed before a decision is made. Consultation and discussion with family members also ensures 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 of such a patient would not be appropriate, but careful evaluation and assessment are vital to ensure the care team is involved in the decision-making process. Non-maleficence holds that no futile treatment should be attempted, as this would constitute harm to the patient — an example being the initiation of CPR on a dying patient.

Ethical Theories Versus Emotional Constructs

Emotional constructs such as intuition and personal feeling are individual expressions that can be affected by a person's mental state. Decisions made when one is emotional may be flawed and lead to severe consequences. Ethical theories, by contrast, require a person to think carefully about any decision before acting upon it. Such deliberation ensures that the person has analyzed both the benefits and risks associated with their decision. Others can support a decision grounded in ethical theory, whereas an emotionally driven decision is difficult to justify to others. Intuition is the ability of a person to sense something without having proof or evidence. In the medical field, where all decisions must be evidence-based, the use of intuition could result in severe consequences for the patient. Intuition differs from ethical theories in that intuition is acquired unknowingly, while ethical theories have been developed through research over time and carry justified support.

Ethical theories are well understood, and a person must analyze them carefully before acting. Emotional constructs, by contrast, lead a person to act based on feelings alone. While emotional constructs may be rooted in empathy for the patient, ethical theories are grounded in what is objectively best for the patient. Emotions can prevent a healthcare professional from performing what is clinically right. Even when a decision is critical, emotional attachment can impair sound judgment. Ethical theories require the healthcare worker to analyze the situation through established frameworks before making a decision, thereby helping caregivers avoid the distortions that emotional constructs can introduce.

Conclusion

Research has shown that in the Netherlands, where euthanasia is legalized, there are fewer palliative care centers compared to Great Britain and the United States. The prohibition of assisted suicide in many countries has allowed for the establishment of more hospice and palliative care services, which promote the health and well-being of patients. The ethical theories that support the caring of patients require the provision of services that ensure terminally ill patients do not suffer unnecessarily. Beneficence and non-maleficence together ensure that a patient receives the best care possible, with a team of professionals and family members collaborating to determine care based on sound medical and personal needs.

Alleviating pain is the primary goal of hospice and palliative services. This is accomplished by offering patients medications that relieve their suffering. Opponents of these services have argued that providing high doses of painkillers is equivalent to assisted suicide. However, palliative services are not equivalent to assisted suicide, because the decision to administer pain relief is not left to a single individual. Having a team of caregivers ensures that all decisions are analyzed, discussed, and collectively agreed upon — a process grounded in the ethical principles of autonomy, beneficence, and non-maleficence.

References

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. 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.

Temel, J.S., Greer, J.A., Muzikansky, A., Gallagher, E.R., Admane, S., Jackson, V.A., . . . Pril, W.F. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. New England Journal of Medicine, 363(8), 733–742.