end of life care

Question 1

End of Life Care - KU

Answer 1

• End of life care is the care that you receive when you are nearing the end of your life
  -For some, end of life care will begin days before the end of their life, while others it may begin months or possibly years before their life ends
• The NHS considers patients to be approaching the end of life when they are ‘likely to die within the next twelve months, although this is not always possible to predict’

Question 2

Planning for the end of life - KU

Answer 2

• Thinking about planning the care you would like to receive at the end of life is something that can happen long before death
• It is something that is often avoided as it ca involve difficult decisions as well as imagining yourself in a scenario that is uncomfortable
• However with regards to autonomy having things in place can ensure that your wishes are respected as well as possibly making things easier for family members and medical professionals as they don’t have to speculate what it is you would have wanted to happen if you can’t communicate to them
• Some of the things that can support planning for the end of life include:
• Advance Care Planning (ACP): advance or anticipatory care planning is a record of the decisions you have made about the care you wish to receive at the end of your life. it is made in partnership with our family and healthcare professionals
• Advance decision to Refuse Treatment (ADRT): this is a decision that you can make in writing to refuse a specific treatment in the future. This include life sustaining treatments such as ventilation and infection fighting antibiotics. ADRTs must be written, signed by you and signed by a witness; they are legally binding
• Power of attorney; this is a legal document that allows you to appoint one or more people (as attorneys) to make decisions on your behalf when you can’t. If you do not have power of attorney in place then, when it comes to healthcare, doctors ultimately make decisions for you in line with what they think are in your best interests

Question 3

Palliative care - KU

Answer 3

• palliative acre is included within end of life care and exists to improve the quality of life of terminally ill patients
• it is often seen as holistic care as it doesn’t just manage the pain and physical suffering that is faced by the patient but also offers psychological, social and spiritual care
• Palliative Care is available in a number of different environments that are significantly different, the four main environments are:
• Paliative care in hospitals: hospital palliative care is delivered over a short period of time by a specialist palliative care team. they will work alongside the patient and devise a plan for the patient to receive further care at a care home, a hospice or there own home. This care is provided by the NHS in the UK
• Palliative Care in care homes; care homes with specially trained staff can offer palliative care. Many believe it is a calmer environment than a hospital in which to receive care, and not having to move makes things more comfortable for the patient. Most care homes are privately run and can be expensive
• Palliative care at home: this allows patients to stay at home and receive palliative care. depending on the situation palliative care nurses may make arranged visits during the day, stay overnight or move into the home on a full-time basis

Question 4

Moral Issues arising from end of life care - Cost

Answer 4

• One of the big moral issues raised with end of life care specifically palliative care is cost
• All types of palliative care are expensive but as we have seen palliative care happens in many different environments with different providers so the burden of that cost lands on different people
• Some have asked should all palliative care be free?
• When patients are admitted to private care home there is a cost that the patient must pay; if they can’t afford this then choices for care can be limited

Question 5

Moral Issues arising from end of life care - Virtue

Answer 5

• Some would argue that forcing palliative care on people when they don’t want it shows a lack of compassion, and that care becomes even less compassionate when people would rather stop that care for the alternative of assisted dying, but are legally denied that choice
• Others argue palliative care brings a greater moral good that the alternative of assisted dying as it is more hollistic and also supports the family or caregivers with things such as bereavement counselling whereas assisted dying simply deals with the patients pain

Question 6

Moral Issues arising from end of life care - Mental health and wellbeing

Answer 6

• Advocates for palliative care believe that it provides the best care for patients at the end of their life including psychological care for the patient
• However those who want assisted dying legalised believe that palliative care without the option of assisted dying is simply drawing out an inevitable death, which is detrimental to a patients mental health and wellbeing

Question 7

Religious responses to End of Life care - Buddhism

Answer 7

• Central to Buddhist belief and practise is the understanding that suffering is a part of human existence and that true liberation only comes from ending that suffering
• This fits in with the principles and practises of good palliative care and its holistic approach at supporting people to navigate suffering
• Therefore it is not surprising that most Buddhists are in favour of Palliative care

Question 8

Religious responses to End of Life care -Church Of Scotland

Answer 8

• Church of Scotland is very much in favour of palliative care as the only option at the end for life
• they state that ‘the Christian tradition provides us with structures of hope meaning and new possibilities even in the midst of pain and suffering’
• This shows the importance of living life even as death approaches
• The church explains that end of life care should not focus on the actual moment of death but rather that end of life period

Question 9

Religious responses to End of Life care - Catholic Church

Answer 9

• Many other Christian traditions mirror this thinking as it upholds the sanctity of life
• The Catechism of the Catholic Church indicates that palliative care is a special form of disinterested charity and as such should be encouraged
• Care and preservation are the number one priority for the Catholic Church as the catechism goes on to explain that ‘were are obliged to accept life gratefully…It is not ours to dispose of’

Question 10

Non Religious responses to End of Life care - BMA

Answer 10

• They are in favour of palliative care
• The BMA does not believe that the system of end of life care is perfect in the UK and a few years back undertook a significant project to explore the provision of care in the UK
• Some of the key points put forward were:
• Although there are examples of excellent end of life care throughout the UK, there is considerable variation depending on where you live and what your illness is
• To address the inconsistencies across the Uk in the end of life care there would need to be significant changes to invest

Question 11

Non Religious responses to End of Life care - Humanist Society Scotland

Answer 11

• They believes that assisted dying should be legalised but not that it should exist as an alternative to palliative care
• Quite the contrary in fact the Humanist Society Scotland has called for investment in palliative care and wishes to raise awareness through end of life charter so that everyone who wishes to access high quality palliative care in Scotland has a right to do so
• they believe palliative care should be available to support for the dying patient until the point when the dying patient chooses to end their life
• This gives the dying patient full autonomy to decide when care begins and when care ends