Posted: August 26th, 2023

Moral Position on Treating Terminal Patients with Palliative Care

Moral Position on Treating Terminal Patients with Palliative Care

Palliative care is a specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. It also can help patients cope with side effects from medical treatments, psychological distress, social isolation, and spiritual concerns. Palliative care is an approach that improves the quality of life of patients and their families who are facing problems associated with life-threatening illness [1][2]. Palliative care is not dependent on the prognosis or the curability of the disease, and it can be provided along with curative or life-prolonging treatments [3].

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The moral position on treating terminal patients with palliative care is based on the ethical principles of beneficence, non-maleficence, autonomy, and justice. Beneficence means doing good for the patient and promoting their well-being. Non-maleficence means avoiding harm or minimizing harm to the patient. Autonomy means respecting the patient's right to make informed decisions about their own care. Justice means ensuring fair and equitable access to palliative care for all patients who need it [4].

According to these principles, treating terminal patients with palliative care is morally justified and desirable, as it can provide the following benefits:

- It can relieve physical suffering, such as pain, nausea, breathlessness, fatigue, and other symptoms that affect the patient's comfort and dignity [5].
- It can address psychological suffering, such as anxiety, depression, fear, anger, guilt, and loss of meaning that affect the patient's mental health and quality of life [6].
- It can support social suffering, such as isolation, loneliness, stigma, discrimination, and lack of resources that affect the patient's relationships and social roles [7].
- It can respect spiritual suffering, such as existential questions, doubts, conflicts, and hopes that affect the patient's beliefs and values [8].
- It can empower the patient to exercise their autonomy and make choices that reflect their preferences and goals of care [9].
- It can involve the family and caregivers in the care process and provide them with emotional, practical, and bereavement support [10].
- It can reduce unnecessary hospitalizations and interventions that may be futile, burdensome, or unwanted by the patient [11].
- It can promote a peaceful and dignified death that honors the patient's wishes and values [12].

Therefore, treating terminal patients with palliative care is a moral duty that respects their human rights and dignity. Palliative care should be available to all patients who need it, regardless of their income, disease type, or age. Palliative care should be integrated into the health system and delivered by a multidisciplinary team of professionals who are trained and competent in this field. Palliative care should be guided by evidence-based standards and quality indicators that ensure its effectiveness and safety [13].

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References:

[1] World Health Organization (WHO). Palliative care. 2020. Available from: https://www.who.int/news-room/fact-sheets/detail/palliative-care
[2] Mayo Clinic. Palliative care. 2020. Available from: https://www.mayoclinic.org/tests-procedures/palliative-care/about/pac-20384637
[3] World Health Organization (WHO). WHO Definition of Palliative Care. 2002. Available from: https://www.who.int/cancer/palliative/definition/en/
[4] Beauchamp TL, Childress JF. Principles of biomedical ethics. 8th ed. New York: Oxford University Press; 2019.
[5] Mercadante S, Aielli F. The role of palliative care in addressing refractory symptoms in advanced cancer patients. Cancers (Basel). 2019;11(6):789.
[6] Breitbart W, Rosenfeld B. Psycho-oncology and palliative care psychiatry: The challenges ahead. Psychooncology. 2019;28(1):3-5.
[7] Kellehear A. Compassionate communities: end-of-life care as everyone's responsibility. QJM. 2013;106(12):1071-5.
[8] Puchalski CM, Vitillo R, Hull SK, Reller N. Improving the spiritual dimension of whole person care: reaching national and international consensus. J Palliat Med. 2014;17(6):642-56.
[9] Mack JW, Smith TJ. Reasons why physicians do not have discussions about poor prognosis, why it matters, and what can be improved. J Clin Oncol. 2012;30(22):2715-7.
[10] Harding R, Higginson IJ. What is the best way to help caregivers in cancer and palliative care? A systematic literature review of interventions and their effectiveness. Palliat Med. 2003;17(1):63-74.
[11] Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733-42.
[12] Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, et al. Associations between end-of-life discussions, patient mental health, medical care near death, write my nursing thesis and caregiver bereavement adjustment. JAMA. 2008;300(14):1665-73.
[13] World Health Organization (WHO). Strengthening of palliative care as a component of comprehensive care throughout the life course. 2014. Available from: https://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_R19-en.pdf

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