Death Flashcards
Effective communication around death + dying:
- open and honest information
- But aligned to the patient’s and relative’s process of uptake and coping with information;
Be attentive to social + cultural differences, the patient’s personality, wishes and needs
Find a balance between transparency and information / carefulness about too much info: adapt to your patient! - Empathy (Effective AND affective)
- clear and understandable language;
- leaving room for positive coping strategies,
- committed health-care professionals - - taking responsibility;
- recognition of relatives in their role as caregiver
4 dimensions of palliative care:
physical, social, spiritual, psychological
Who do we just ‘treat, treat, treat’?
- Talking about death is unusual
- ‘Never give up’ is the default attitude in our society.
- Doctors: ‘ending curative treatment = stopping treatment’
- Action is better than inaction (hence: treat!).
- Guidelines + education focus on ‘action’.
- Payment for treatment
- Palliative care comes too late, is misunderstood and undervalued
- Discussing possible refusal of treatment is more time-consuming.
- Talking is difficult. What should we talk about? Who should talk with patients about death? How should it be done? How to acknowledge differences (culture, perspectives on life, etc.)
- People document their wishes and preferences regarding end-of-life care too late, and often not thoroughly enough (advance directives)
Solutions to encourage palliative care over treat treat treat
- Make end-of-life acceptance and talking about death more common
- Greater clarity on patients’ wishes and improved coordination, including handover, Advance Care Planning
- Shared and improved decision-making
- Guidelines should be directed not only at ‘action’ but also at ‘inaction’ (alternative action)
- Shift the focus of the healthcare system from production to appropriateness (value based health care, person centered health care)
Ethical challenges in Dutch Palliative Care
Guidelines & protocols
Interprofessional collaboration
Dealing with patient wishes
Euthanasia / assisted dying / withdrawal of treatment
Professional role & boundaries
Interaction w/ family members & informal caretakers
Issues that may be seen as morally troublesome (+ req Clinical Ethics Support):
‘Awkward situation’
Uncertainty: not knowing what is the right or wrong thing to do in the situation.
Something important, not trivial
Clinical Ethics Support (Options):
Clinical Ethics Consultation (asking an ethicist for advice)
Clinical Ethics Committee
Moral Case Deliberation
What is a moral case deliberation
A structured dialogue between practitioners about their moral question (preferably interdisciplinary)
Exploring a concrete case
Departing from a moral dilemma
Focusing on personal moral experience
Exploring values and norms of the participants and stakeholders
Sharing individual weighings of the dilemma in a dialogue
Searching for a common ground, a shared horizon
Facilitated by an ethicist
Dichotomy: non-person/person
Caused by: science + technology, popular culture, ideology clash
Qualities of full moral status:
-(Self-)Consciousness (potential)
-Sentience (potential)
-Separateness (potential, viability)
-Life (yes but not complex yet)
-Humanity (yes)
FLO argument:
Death = loss of all future activities that may not be values atm but may be valued as one grows and their values + capacities change. Being killed deprives both what one values now which would be part of their future but also what they may come to value
Counter-arguments: sperm + oocytes also have FLO
