Ethical problems of palliative care in the period of its evolutionary transformation

Our long-time experience in palliative care allowed us to notice changes in ethics of palliative medicine. In the handbook of palliative medicine, its authors R.G.Twycross and D.Frampton in 1995 did formulate the following ethical postulate: respect for life, acceptance of death of a patient as an unavoidable event, respect for a patient as a person, beneficence, nonmaleficence, justice. In addition, they stressed prohibition of euthanasia as a rule. Nine years later, however, in the Oxford handbook of palliative care, its authors: M.S.Watson, C.T.Lukas, M.A.Hoy and J.N.Back described their ethical basis, which were slightly different but quite similar to those of T.L.Beauchamp and J.F.Childers: autonomy of a patient, beneficence, nonmaleficence, justice and the trust. Their set of principles may induce controversy because of unlimited patient's autonomy and absence of physician's autonomy. Further, it may permit euthanasia, which is excluded by palliative medicine

Ethical aspect of quality of life of palliative care patients

In the paper, we attempt a semantic analysis of patient quality of life, which plays an important role in evaluating the patient’s condition and health. The issue seems to be the most important in palliative-hospice care, where doctors work with seriously or terminally ill patients. One of the aims of this branch of medicine is to improve quality of life. This may be achieved, among others, by recognizing the current problems the patient is facing pertaining to family and social relations, beliefs, views or religion. Moreover, by monitoring the behavior of patients and symptoms of their illnesses, the best therapy methods may be selected. Patient quality of life assessment may also enable comparing health care units of the same specialization and be used for the selection of the best standards of care. When discussing the broader meaning of "quality of life", we caution against equating quality of life with the value of life. The main arguments are as follows: subjective character of evaluation of quality of life and, in the future, the possibility of postulates for shortening life of poor quality of life patients when funds for their treatment are insufficient. When accepting quality of life as equal to the value of life, it may result in eliminating unprotected and helpless patients and allowing only the strong to live. Later, this may result in the discrimination of seriously and terminally ill people, even those who do not wish to shorten their lives despite experiencing burdensome symptoms and being aware of the incurable nature of their illness

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