Application of METAP methodology for clinical ethics consultation in end-of-life care in Bulgaria

2020 ◽  
Vol 15 (4) ◽  
pp. 204-212
Author(s):  
Silviya Stoyanova Aleksandrova-Yankulovska
Keyword(s):  
End Of Life ◽  
Clinical Ethics ◽  
End Of Life Care ◽  
Ethics Consultation ◽  
Biomedical Ethics ◽  
Clinical Ethics Consultation ◽  
Life Care ◽  
Social Good ◽  
Unequal Treatment ◽  
The Usa

Although clinical ethics consultation has existed for more than 40 years in the USA and Europe, it was not available in Bulgaria until recently. In introducing clinical ethics consultation into our country, the Modular, Ethical, Treatment, Allocation of resources, Process (METAP) methodology has been preferred because of its potential to be used in resource-poor settings and its strong educational function. This paper presents the results of a METAP evaluation in a hospital palliative care ward in the town of Vratsa. The evaluation was based on Beauchamp and Childress’ four principles of biomedical ethics and involves implementation of specific instruments for clinical ethics decision-making. Research tasks emphasised analyses of ethics meetings in the ward. Data were processed by SPSS v.24 using descriptive statistical analysis. Altogether, 32 ethics meetings of an average duration 20.63 min were conducted on cases involving critically ill patients. Most of the participants (86.0%) expressed satisfaction with the ethics process. The principlist approach supported resolution of conflicts between autonomous patients and their relatives, clarified definitions of “medical benefit” and “social good,” and enabled assessments of the risk of unequal treatment. Even as the specific research tasks were achieved, further participant follow-up is necessary to identify any improvement in healthcare personnel’s ethical competence. METAP worked well in end-of-life care settings. Participants experienced several benefits, including improved team communication, better understanding of patient preferences, and confidence in the correctness of decisions. Despite the significant educational potential of METAP, the need for additional and ongoing ethics training of health professionals should not be underestimated.

scholarly journals Ethical considerations at the end-of-life care

2021 ◽  
Vol 9 ◽  
pp. 205031212110009
Author(s):  
Melahat Akdeniz ◽  
Bülent Yardımcı ◽  
Ethem Kavukcu
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Assisted Suicide ◽  
Healthcare Professionals ◽  
Ethical Decision Making ◽  
Biomedical Ethics ◽  
Artificial Nutrition ◽  
Life Care ◽  
Ethical Challenges ◽  
Physician Assisted Suicide

The goal of end-of-life care for dying patients is to prevent or relieve suffering as much as possible while respecting the patients’ desires. However, physicians face many ethical challenges in end-of-life care. Since the decisions to be made may concern patients’ family members and society as well as the patients, it is important to protect the rights, dignity, and vigor of all parties involved in the clinical ethical decision-making process. Understanding the principles underlying biomedical ethics is important for physicians to solve the problems they face in end-of-life care. The main situations that create ethical difficulties for healthcare professionals are the decisions regarding resuscitation, mechanical ventilation, artificial nutrition and hydration, terminal sedation, withholding and withdrawing treatments, euthanasia, and physician-assisted suicide. Five ethical principles guide healthcare professionals in the management of these situations.

scholarly journals Financing End-of-Life Care in the USA

2001 ◽  
Vol 94 (9) ◽  
pp. 458-461 ◽  
Author(s):  
Carol Raphael ◽  
Joann Ahrens ◽  
Nicole Fowler
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
The Usa

scholarly journals End-of-life care and dementia

2005 ◽  
Vol 15 (2) ◽  
pp. 135-148 ◽  
Author(s):  
Louise Robinson ◽  
Julian Hughes ◽  
Sarah Daley ◽  
John Keady ◽  
Clive Ballard ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Current Knowledge ◽  
Patient Choice ◽  
Life Care ◽  
Current Standard ◽  
People With Dementia ◽  
National Service Framework ◽  
The Usa ◽  
The Uk

In the UK, research continues to confirm that people with certain chronic illnesses, such as chronic lung disease and cardiac failure, represent the ‘disadvantaged dying’ compared to those with terminal cancer. But what is the situation for people dying with advanced dementia and what is the experience of their carers? Practical guidance for clinicians is scarce. In Standard 7 of the National Service Framework for Older People, which covers mental health, there is mention neither of how care should be provided nor of how patient choice should be ensured for people with dementia at the end of life. In the UK, 5% of the population aged 65 and over and 20% of those aged 80 and over have dementia similar prevalence figures are found in the USA. Current predictions suggest that the number of people with dementia will increase by 40% by 2026 and will double by 2050. The increased demand for end-of-life care for people with dementia will be associated with major social and economic costs, but what is the current standard of such care? How can the quality be improved? And how should future services be configured to cope with this increasing need? In this paper, we review current knowledge around end-of-life care in dementia, discuss the clinical challenges and ethical dilemmas presented to carers, consider the difficulties in delivering such care and suggest practical approaches to improve the quality of such care.

scholarly journals Clinical ethics of end-of-life care in an emergency medical center

2012 ◽  
Vol 23 (2) ◽  
pp. 39-50
Author(s):  
Asako Matsushima ◽  
Naoko Ogawa ◽  
Hiroshi Ogura ◽  
Takeshi Shimazu ◽  
Motomu Shimoda ◽  
...  
Keyword(s):  
End Of Life ◽  
Clinical Ethics ◽  
End Of Life Care ◽  
Medical Center ◽  
Life Care ◽  
Emergency Medical

Clinical ethics consultation in oncology.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9121-9121
Author(s):  
Andrew G Shuman ◽  
Sacha M Montas ◽  
Andrew R Barnosky ◽  
Lauren B Smith ◽  
David W Kissane ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Advance Directives ◽  
Professional Education ◽  
Clinical Ethics ◽  
Interpersonal Conflict ◽  
Ethics Consultation ◽  
Clinical Ethics Consultation ◽  
Goals Of Care ◽  
Code Status

9121 Background: There is limited empirical research exploring the nature of clinical ethical consultations within the oncology population. Our objective is to review, describe and compare clinical ethics consultations at two NCI-designated comprehensive cancer centers, in order to identify opportunities for systems improvement in clinical care. Methods: This case series is derived from prospectively-maintained clinical ethics consultation databases at each institution. All adult oncology patients receiving ethics consultation from 2007 through 2011 were included as eligible cases. Both qualitative and quantitative analyses were undertaken. Demographic and clinical information were obtained from the databases for all patients, and verified via chart abstraction. Additional variables studied included the reason for and context of the ethical consultation, the patient’s code status before and after consultation, and involvement of palliative care or other adjuvant services. Opportunities for systems-level improvements and/or educational initiatives were identified. Results: A total of 207 eligible cases were identified. The most common primary issues leading to ethics consultation were code status and advance directives (25%), surrogate decision-making (17%), and medical futility (13%). Communication lapses were identified in 41%, and interpersonal conflict arose in 51%. Prior to ethics consultation, 26% of patients were DNR; 60% were DNR after ethics consultation. Palliative care consultation occurred in 41% of cases. Opportunities for systems improvement and professional education related to goals of care at the end of life, the role of palliative care involvement, and improved communication. Conclusions: Ethics consultations among cancer patients reflect the realities inherent to their clinical management. Appropriately addressing advance directives within the context of overall goals of care is crucial. Thoughtful consideration of communication barriers, sources of interpersonal conflict, symptom control, and end-of-life care are paramount to optimal management strategies in this patient population.

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