End-of-Life Care:

Contents

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Foreword

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pp. 4-5

In recent years in this country there has been an increasing interest in what are generally described as end-of-life issues. While many surveys have shown that the majority of people would prefer to die in their own homes, the fact is that most of us die in hospital or other centres of institutional care such as nursing homes or hospices. At times the circumstances surrounding the terminally ill at the time of their death are far from ideal. While this is, of ...

Introduction

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pp. 7-20

The Framework is the outcome of a unique collaboration between University College Cork, the Royal College of Surgeons in Ireland and the Irish Hospice Foundation, with contributions from ethicists, legal experts, theologians, sociologists and clinicians. It draws on a range of values and principles that have been identified as important considerations in end-of-life decision making by international experts in bioethics and by professional codes of ...

Module 1: Explaining Ethics

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pp. 21-67

1.1 Ethics, or moral philosophy: considers theories about what human beings are capable of doing, alongside accounts of what they ought to do if they are to live an ethically good life. Ethics may share common ground with the law, religious belief, popular opinion, professional codes, hospital policies and the dictates of authority figures, but it is also broader than all of these and offers a set of tools and values against which their appropriateness can be evaluated. ...

Module 2: The Ethics of Breaking Bad News

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pp. 69-114

... 1.3 Arguments for and against breaking bad news: generally appeal to basic ethical principles such as respect for patient autonomy, doing good and avoiding harm. Objections to disclosure also appeal to serious ethical considerations such as worries about avoiding harm, ensuring patient well-being and maintaining hope. ...

Module 3: Healthcare Decision-making and the Role of Rights

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pp. 115-157

... 1.2 Moral rights and legal rights are different: A person may have a moral right to something but this moral right may not be enforceable in a court of law. This does not mean that the moral right is less important than a legal right. However, it can mean that a moral right is more difficult to enforce. ...

Module 4: Patient Autonomy in Law and Practice

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pp. 159-210

... 1.3 Autonomy is a contested notion: There is ongoing debate among healthcare ethicists and others regarding the proper status for autonomy. For some, autonomy provides the basis for patient rights and is the most important of all the ethical standards. However, this claim is disputed by others who place importance on values such as trust and maintaining personal and social relationships. ...

Module 5: The Ethics of Managing Pain

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pp. 211-264

1.1 Bad deaths: often occur as a result of poor pain and symptom management, inadequate communication and the experience of abandonment and isolation. Very often bad deaths occur where there is inappropriate and, arguably, unethical active treatment and when obstacles prevent patients from accessing palliative care. ...

Module 6: The Ethics of Life-Prolonging Treatments (LPTs)

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pp. 265-338

1.1 Advance care planning (ACP): is at the centre of efforts to promote patient-centred care. ACP offers choice and respects the right of persons to consent to or refuse treatment and care offered. At present, legislation in Ireland covering advance care plans such as advance directives is not available, though in 2009 the Law Reform Commission published a report recommending that provisions be put in place to recognise validly drawn ...

Module 7: The Ethics of Confidentiality and Privacy

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pp. 339-385

1.1 Confidential information is private information: that a person shares with another on the understanding that it will not be disclosed to third parties. It includes identifiable patient information – written, computerised, visually or audio recorded – that health professionals have access to. Keeping patient confidentiality is important because it builds trust, respects patient ...

Module 8: Ethical Governance in Clinical Care and Research

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pp. 387-460

1.1. There is a need for formal ethics support in clinical practice: Recent advances in biomedical technology and the identification of an increased range of values and needs in the patient population have led to a growing awareness of the complexity of healthcare provision and the need for formal ethics support for health professionals in the day-to-day treatment of patients. In the US and UK, this support most commonly takes the form of a healthcare ...

Index

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pp. 461-468