Problem Statement

In end-of-life care or palliative care the ethical implications present significant challenges. The core dilemma involves balancing respect for patients’ autonomy and right to self-dignity vs the wish of a hasten death or belief of ill intent by providers. In other words, we try to respect the patient’s wishes but sometimes our intent to respect one’s wishes can be perceived as harmful. Clinicians must adopt a societal, cultural, and legal approach when managing these sensitive requests.

Insights from Literature Review

In my literature review, I realized that end of life care involves addressing complex ethical challenges, particularly regarding critically ill patients. Palliative sedation is highlighted by Bhyan et al. (2024) and Olsen et al, (2010) as a crucial practice for alleviating symptoms like pain and agitation, thus maintaining patient dignity and ensuring a peaceful death. Using medications like morphine and Ativan help achieve this. We must be clear that this is not euthanasia rather it is a focus on symptom relief rather than hastening death (Bhyan et al., 2024). Determining palliative sedation involves evaluating symptoms and potential adverse outcomes. Olsen et al. (2010) emphasizes consensus among families, patients, and the healthcare team. Effective communication and education is key in reducing misunderstanding, with palliative care teams advocating for patient comfort as a priority.

Patient dignity, a pivotal aspect of end-of-life care, is examined in the scholar article by Kennedy (2016) and Borges et al. (2024). Kennedy (2016) describes dignity as encompassing respect, autonomy, empowerment, and communication, preserved through symptoms management and empathetic dialogue, addressing emotional and spiritual needs. For example, by partner and I work ICU and see what poor quality of life looks like firsthand. So, we understand that we do not want to end up in that situation and want to keep our dignity, so we have spoken about our wishes if anything where to happen to either of us. Borges et al. (2024) investigates the ethical implications of “wishes to hasten death,” tying these desires to psychosocial and spiritual factors while emphasizing ethical principle like autonomy and dignity. The need for compassionate, ethically sensitive healthcare practices is highlighted, with emphasis on the need to improve understanding and informed clinical consent. Together, these studies underscore the significance of patient dignity and ethical considerations, advocating for personalized, compassionate care that respect patient autonomy.

References
Bhyan, P., Pesce, M. B., Shrestha, U., & Goyal, A. (2024, January 19). Palliative sedation in patients with terminal illness. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK470545/Links to an external site.

Olsen, M. L., Swetz, K. M., & Mueller, P. S. (2010). Ethical decision making with End-of-Life care: palliative sedation and withholding or withdrawing Life-Sustaining treatments. Mayo Clinic Proceedings, 85(10), 949–954. https://doi.org/10.4065/mcp.2010.0201Links to an external site.

Kennedy, G. (2016, January 1). The importance of patient dignity in care at the end of life. https://pmc.ncbi.nlm.nih.gov/articles/PMC4847835/Links to an external site.

Borges, P. J., Hernández-Marrero, P., & Pereira, S. M. (2024). A bioethical perspective on the meanings behind a wish to hasten death: a meta-ethnographic review. BMC Medical Ethics, 25(1). https://doi.org/10.1186/s12910-024-01018-y