Ethics of End of Life Care

Chan Tuck WaiB.Sc. (Pharmacy), MBACertified IRB Professional (USA)Human Protection AdministratorNational University Hospital, National University of Singapore

What do I want during my last 6 months?

A Healthy BirthA Happy LifeA Good Death

12 Principles of Good Death

Understand Death Retain Control Dignity and Privacy Control Pain Place of Death Access to Info,

Experts

Spiritual Support Hospice Care Who will share my

end Advance Directives Time to say Goodbye No prolongation of

suffering

The Truth

• There is a major mismatch between people’s preferences for where they should die and their actual place of death

• Most would probably like to die at home • Only around 18% do so with a further 17% in care

homes• Acute hospitals accounting for 58% of all deaths• Around 4% in hospices

• Only around one third of general public have discussed death and dying with anyone

What is EOL care?

Key domain of Care Physical Psychological Social Spiritual

Key aspect of Care Symptoms Control Comfort measures Anticipatory prescribing of medication Discontinuation of inappropriate interventions Psychological and spiritual care Care of the family

Sufferings of EOL

Pain Sleep Breathing Metabolic Digestive Skin Emotional

Kubler-Ross model on EOL patients

Denial – “I feel fine, This can’t be happening, not to me.”

Anger – “Why me? It’s not fair! Who is to blame?”

Bargaining – “Just let me live to see my children graduate”

Depression – “Why bother with anything? What’s the point?”

Acceptance – “I am going to ok, I Can’t fight it, I may as well prepare for it.”

Improve Quality of Life

Symptomatic relief Adding life to days and not days to life First DO not Harm Treatment should not be a burden QOL improves despite not finding CURE End point is Death

Ethics Consideration

Respect Beneficence Non-Maleficence Justice

Respect is most Important

Respect for patients Respect for family Voluntary Informed Consent Every treatment must be explained and

accepted by the patient and family Role of family in patient care

Communication is crucial

Communicate regularly with patients and care givers

Communicate with previously consulted practitioners to obtain patient’s medical history and emotional state of mind

Must learn to LET GO

Thank You

Questions and Answers