Ethical issues in palliative and end-of-life care

Many ethical issues arise for individuals near the end of life, their healthcare providers, and their families. Preeminent ethical issues concern the balance of patient autonomy and provider beneficent responsibility, provider beneficent responsibility and nonmaleficence, and issues of justice. Ethical considerations arise in various treatment settings, and we provide case examples involving ethical dilemmas and interprofessional team responses. Particular attention is given to the process of shared decision-making and whose perspective in the treatment triad (patient, provider, and family members) is considered the “gold standard.” Moreover, contextual considerations of decisional capacity, health literacy, and culture are addressed, particularly when there is disagreement between parties. This chapter summarizes and evaluates current international literature on physician-assisted death legislation and evaluations of capacity to choose this hastened death. The chapter concludes with a discussion of interventions to improve ethical practice, particularly educational interventions regarding palliative care, the formation of interdisciplinary teams, and the potential inclusion of family members in interdisciplinary treatment team meetings.