Balancing the many aspects of the ethical endings debate

The public debate on end-of-life ethics is (in the main) focussed on what’s being described as a personal choice issue.

The public debate on end-of-life ethics is (in the main) focussed on what’s being described as a personal choice issue. When and how one becomes involved in making decisions that can have an immediate effect on ones ability to continue living, breathing and functioning in human community.

While the courts and the various interested parties weigh in on that very important and necessary conversation, it is far from the only ethical consideration we will face as we transition out of life ourselves; are present to the transition of family members; or act as care-givers during the time of transition we know as dying, or end-of-life.

We will, and do, come into points of convergence at the end-of-life, points that concern conflicting values; differing cultural mores; legal principles; institutional policies; the goals of treatment and the various needs of the people and organizations involved.

As those convergences come into being, we can benefit greatly from a good grounding in a sound decision making process.

It helps if we have a basic understanding of ethical principles (do no harm; what is the course of most benefit to the patient?; how do we allow for autonomy, justice and fidelity in the course of patient care?).

It is important that we are familiar with policies and structures put in place by care providers that will help us resolve ethical dilemmas, and the voices of patients and those who speak for them must be part of the process. But who decides if a matter is an ethical dilemma or not?

Patients and their families have a great deal to say and offer, especially if they are given information in a manner that meets their needs.

Sometimes patient and family decisions conflict with the ethical/legal responsibilities of the wider social system. How do we make choices that honour those decisions while upholding the needs of society at large?

How can we, as patients (and we will all be patients one day) help physicians and family members know our wishes and feel supported in abiding by them? How can we ensure that they are not open to action in our courts?

When we have been clear about our wishes, how do health-care providers act upon them? What medications and treatments are appropriate to the goal of neither hastening nor unnaturally delaying death?

How do we impart, receive and retain information as either health-care providers, patients or their spokespersons about the choices available and the potential effects they might have?

How do organizations support staff who may experience moral anguish as they administer or do not administer treatment in accordance with the wishes of the patient?

As you can see, there are a number of ethical issues at the end-of-life. Our local hospice society is pleased to be part of the conversation. This month, we explored these and other topics with members of our community. For information on upcoming conversations, please call the Greater Trail Hospice Society offices at: 250 364 6204 or at