Legal issues in end-of-life care 2: consent and decision-making

2020 ◽  
Vol 12 (11) ◽  
pp. 1-6
Author(s):  
Helen Taylor
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
End Of Life Care ◽  
Legal Framework ◽  
Legal Issues ◽  
Decision Making Process ◽  
Life Care ◽  
General Requirement ◽  
Cardio Pulmonary Resuscitation ◽  
Advance Decisions

Paramedics are legally and professionally obliged to uphold their patients' right to dignity, respect and autonomy—and this includes the general requirement to obtain their consent before proceeding with any intervention. The first instalment of this two-part article considered the challenges that this might present to the paramedic. This second article develops this theme and further explores the legal framework underpinning the decision-making process when caring for a patient approaching the end of life. It also examines issues around consent and mental capacity in more depth and addresses matters such as such as advance decisions to refuse treatment (ADRT) and do not attempt cardio-pulmonary resuscitation (DNACPR) decisions.

End-of-life care part 1: implications for paramedic practice

2020 ◽  
Vol 12 (9) ◽  
pp. 1-5 ◽  
Author(s):  
Helen Taylor ◽  
James Brogan
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
End Of Life Care ◽  
Mental Capacity ◽  
Life Care ◽  
Long Period ◽  
Life Sustaining Treatment ◽  
Advance Decisions ◽  
Unexpected Outcome ◽  
Dying Patient

Caring for patients who are approaching the end of life is an important part of the paramedic's role. Patients' circumstances are individual; for some, death is expected and may even a welcome (albeit sad) relief from a long period of pain and distress, while for others it is a tragic, unexpected outcome after every effort to prevent it has been exhausted. Regardless of circumstances, paramedics have to make wide-ranging clinical decisions, underpinned by a complex legal and regulatory framework. Paramedics generally have to obtain a patient's informed consent before proceeding with any intervention. They may be challenged if a dying patient refuses life-sustaining treatment or no longer has the mental capacity to consent and need to know the law on decision-making in these cases. This article discusses issues around capacity and consent at the end of life. The next article in this series considers issues such as advance decisions to refuse treatment and do not attempt CPR decisions.

Doctors’ reports about palliative systemic treatment: A medical record study

2016 ◽  
Vol 31 (3) ◽  
pp. 239-246 ◽  
Author(s):  
Hilde M Buiting ◽  
Mirian Brink ◽  
Marleen N Wijnhoven ◽  
Martine E Lokker ◽  
Lydia GM van der Geest ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Medical Record ◽  
Medical Records ◽  
End Of Life Care ◽  
Systemic Treatment ◽  
Decision Making Process ◽  
Drinking Behaviour ◽  
Life Care

Background: Decisions about palliative systemic treatment are key elements of palliative and end-of-life care. Such decisions must often be made in complex, clinical situations. Aim: To explore the content of medical records of patients with advanced non-small cell lung cancer and pancreatic cancer with specific emphasis on doctors’ notes about decisions on palliative systemic treatment. Design: Medical record review (2009–2012) of 147 cancer patients containing 276 notes about palliative systemic treatment. We described the proportion of notes/medical records containing pre-specified items relevant to palliative systemic treatment. We selected patients using the nationwide Netherlands Cancer Registry. Setting: Hospital based. Results: About 75% of all notes reported doctors’ considerations to start/continue palliative systemic treatment, including information about the prognosis (47%), possible survival gain (22%), patients’ wish for palliative systemic treatment (33%), impact on quality of life (8%), and patient’s age (3%). Comorbidity (82%), smoking status (78%) and drinking behaviour (63%) were more often documented than patients’ performance status (16%). Conversations with the patient/family about palliative systemic treatment were reported in 49% of all notes. Response measurements and dose adaptations were documented in 75% and 71% of patients who received palliative systemic treatment respectively. Conclusion: Medical records provide insight into the decision-making process about palliative systemic treatment. The content and detail of doctors’ notes, however, widely varies especially concerning their palliative systemic treatment considerations. Registries that aim to measure the quality of (end-of-life) care must be aware of this outcome. Future research should further explore how medical records can best assist in evaluating the quality of the decision-making process in the patient’s final stage of life.

End-of-Life Decision Making in the Seriously Ill Hospitalized Patient: An Organizing Framework and Results of a Preliminary Study

2000 ◽  
Vol 16 (1_suppl) ◽  
pp. S31-S39 ◽  
Author(s):  
Daren K. Heyland ◽  
Joan Tranmer ◽  
Deb Feldman-Stewart
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Information Exchange ◽  
End Of Life Care ◽  
Decision Making Process ◽  
Life Care ◽  
Preliminary Study ◽  
End Of Life Decision ◽  
Seriously Ill ◽  
Life Decision

Recent studies of patient/family satisfaction with end-of-life care suggest that improvements in communication and decision making are likely to have the greatest impact on improving the quality of end-of-life care. The apparent failure of recent studies specifically designed to improve decision making strongly suggest that there are powerful determinants of the decision making process that are not completely understood. In this paper, we present an organizing framework that describes the decision making process and breaks it into three analytic steps: information exchange, deliberation, and making the decision. In addition, we report the results of a preliminary study of end-of-life decision making that incorporates aspects of this organizing framework. Thirty-seven seriously ill hospitalized patients were interviewed. The majority wanted to share decisional responsibility with physicians. We demonstrated the feasibility of measuring certain aspects of the decision making process in such patients. By providing and using a framework related to end-of-life decision making, we hope to better understand the complex interaction and processes between dying patients, caregivers, and physicians.

scholarly journals Developing an applied model for making decisions towards the end of life about care for someone with dementia

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252464
Author(s):  
Nathan Davies ◽  
Tanisha De Souza ◽  
Greta Rait ◽  
Jessica Meehan ◽  
Elizabeth L. Sampson
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Plan ◽  
Decision Making Process ◽  
Life Care ◽  
Family Carers ◽  
Modified Model ◽  
People With Dementia ◽  
Advance Care

Background Many people with dementia reach the end-of-life without an advance care plan. Many are not ready to have conversations about end-of-life, and decision-making is left to their families and professionals when they no longer have capacity. Carers may benefit from further support with decision-making. To develop this support, it is important to understand the decision-making process. Aim Explore with family carers and people living with dementia the decision-making process and factors that influence decision-making in dementia end of life care, to produce a model of decision-making in the context of dementia end-of-life care. Methods Semi-structured interviews with 21 family carers and 11 people with dementia in England (2018–2019) from memory clinics, general practice and carer organisations. Interviews were analysed using thematic analysis and findings were mapped onto the Interprofessional Shared Decision Making model, refined to produce a modified model of decision-making in dementia. Results Participants described five key decisions towards the end-of-life as examples of decision making. We used these experiences to produce a modified model of decision-making in dementia end-of-life-care. The model considers the contextual factors that influence the decision-making process, including: personal preferences; advance care planning and Lasting Power of Attorney; capacity and health and wellbeing of the person with dementia; support from others and clarity of roles. The decision-making process consists of seven inter-linked stages: 1) identifying the decision maker or team; 2) sharing and exchanging information; 3) clarifying values and preferences; 4) managing and considering emotions; 5) considering the feasibility of options; 6) balancing preferred choice and the actual choice; and 7) implementation and reflecting on outcomes. Conclusions The modified model breaks down the decision-making process and attempts to simplify the process while capturing the subtle nuances of decision making. It provides a framework for conversations and supporting decisions by carers.

scholarly journals A kommunikáció és az önrendelkezés javításának lehetőségei az életvégi döntések meghozatalánál az intenzív osztályokon

2016 ◽  
Vol 157 (17) ◽  
pp. 669-674 ◽  
Author(s):  
László Zubek
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
End Of Life Care ◽  
Medical Science ◽  
Legal Regulation ◽  
Decision Making Process ◽  
Life Care ◽  
Advanced Directives ◽  
Substituted Judgement ◽  
End Of Life Decision

The end-of-life decision making process normally based on patient autonomy or substituted judgement. If the patient can express his/her wishes, one must take note of his autonomy. If he/she is unable to self-determination, the importance of advanced directives or substituted judgement increases in the field of end-of-life care. The most important target of the efforts is to improve end-of-life care at intensive care units. Based on bioethical studies of the author and international literature this paper analizes the practice of end-of-life care and presents recommendations for lawmakers. The author proposes to divide patients with organ failure into three parts (end-of-life triage). The first part includes definitely salvageable, the second part definitely unsalvageable, and the third part possibly salvageable groups. This classification depends on the development of medical science and the local options of medical treatment. The quality of the decision-making process can be improved, but all participants must participate and medio-legal regulation must be improved. Orv. Hetil., 2016, 157(17), 669–674.

Patient Autonomy and Medical Paternity: can nurses help doctors to listen to patients?

2001 ◽  
Vol 8 (6) ◽  
pp. 510-521 ◽  
Author(s):  
Sarah Breier-Mackie
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
End Of Life Care ◽  
Patient Autonomy ◽  
Clinical Encounter ◽  
Decision Making Process ◽  
Life Care ◽  
Advanced Cancer Patient ◽  
Prolongation Of Life ◽  
Medical Paternalism

Nurses are increasingly faced with situations in practice regarding the prolongation of life and withdrawal of treatment. They play a central role in the care of dying people, yet they may find themselves disempowered by medical paternalism or ill-equipped in the decision-making process in end-of-life situations. This article is concerned with the ethical relationships between patient autonomy and medical paternalism in end-of-life care for an advanced cancer patient. The nurse’s role as the patient’s advocate is explored, as are the differences between nursing and medicine when confronted with the notion of patient autonomy. The impetus for this discussion stems from a clinical encounter described in the following scenario.

scholarly journals Nurses’ ethical decision-making during end of life care in South Korea: a cross-sectional descriptive survey

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Arum Lim ◽  
Sanghee Kim
Keyword(s):  
Decision Making ◽  
Linear Regression ◽  
End Of Life ◽  
End Of Life Care ◽  
Ethics Education ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Decision Making Process ◽  
Life Care ◽  
Moral Sensitivity

Abstract Background Although nurses are crucial to ensure patients’ peaceful death in hospitals, many nurses experience various ethical conflicts during end-of-life care. Therefore, research on nurses’ entire ethical decision-making process is required to improve nurses’ ethical decision-making in end-of-life care. This study aimed to identify Korean nurses’ ethical decision-making process based on their moral sensitivity to end-of-life patients. Methods In total, 171 nurses caring for terminal patients responded to the survey questionnaire. To measure the participants’ moral sensitivity and ethical decision-making process, we used the Korean version of the Moral Sensitivity Questionnaire and Nurses’ Ethical Decision-Making around End of Life Care Scale. Finally, multiple linear regression analysis was used to investigate the effect of moral sensitivity on nurses’ ethical decision-making. Results The mean of moral sensitivity was 4.8 ± 0.5 (out of 7), and that of ethical decision-making was 4.6 ± 0.5 (out of 6). Among the sub-dimensions of ethical decision-making, the highest score was in perceived professional accountability (5.2 ± 0.5), and the lowest in moral reasoning and moral agency (3.9 ± 0.6); the score of moral practice was 4.4 ± 0.7. In the multiple linear regression model, moral sensitivity (β = 0.852, p < .001), clinical department (β =  − 7.018, p = .035), ethics education (β = 20.450, p < .001), job satisfaction (β = 5.273, p < .001), and ethical conflict (β =  − 2.260, p = 0.031) were influential ethical decision-making factors. Conclusions This study revealed a gap between nurses’ thoughts and practices through the ethical decision-making process. They failed to lead their thought to moral practice. It also implies that moral sensitivity could positively affect nurses’ ethical decision-making. To make nurses morally sensitive, exposing them to various clinical cases would be helpful. Additionally, ethics education and clinical ethics supporting services are valuable for improving nurses’ ethical decision-making. If nurses improved their ethical decision-making regarding end-of-life care, their patients could experience a better quality of death.

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