Reflecting on the Ethics of End of Life Care

Dr Monika WilsonReConnections Counselling Servicewww.reconnectionscounselling.com

• To deepen our understandings of what constitutes end of life care ethics

• To consider the ethics of our practice and what frameworks of understanding we bring to our work

• To develop greater awareness of what assumptions and interpretations we bring to the ethics of our practice

• To construct ethical maps by which to guide our practice

•What is end of life care ethics?

• Creating and sustaining relationships which mutually recognise the needs, interests and aspirations of all participants as ‘ends in themselves’. The focus is on the continuing enhancing of the other and the self within the human social condition as it is actualised within specific situations, roles, practices, institutions and cultures. In short, applied ethics seeks to enhance the ethical form of life (Isaacs & Massey, 1994).

What guides you?

• Invisible moral framework (compass)

• Ethical articulation: is the process whereby the ‘tacit background’ or what is unsaid about the ethical domain is expressed and acknowledged

Sources of morals/ethics

• Organisational (written/unwritten)

• Professional codes

• Covenantal relationship with community

• Family traditions

• Personal values

• Religious or spiritual beliefs

• Cultural influence

Guide to Ethical ConductIn accordance with our expertise and in the context of our relationship to residents we commit ourselves to protect the following rights of our residents:1.the right of individuals to be treated with respect;2.the rights of the individual to life, liberty, and security;3.the right of individuals to have their religious and cultural identity respected;4.the right of competent individuals to self-determination;5.the right to an appropriate standard of care to meet individual needs;6.the right to privacy and confidentiality;7.the recognition that human beings are social beings with social needs.

And we will protect these rights no matter how frail, physically or mentally disabled, or financially, socially or psychologically vulnerable, the resident may be (Guide to Ethical Conduct for Providers of Residential Aged Care, DoHA, 2012)

Code of Ethics for Nurses (ANMC)

• Nurses value quality nursing care for all people

• Nurses value respect and kindness for self and others

• Nurses value the diversity of people

• Nurses value access to quality nursing and health care for all people

• Nurses value informed decision making

• Nurses value a culture of safety in nursing and health care

• Nurses value ethical management of information

• Nurses value a socially, economically and ecologically sustainable environment promoting health and wellbeing

Video: In the End• What ethical principles did you

notice?• What values did you notice?• What reactions did you have?• Who did you most resonate with?

You have been caring for Martha now for nearly a year. She has advanced Parkinson’s Disease. You have grown quite fond of her. Her husband, John, comes in everyday to sit with her and have lunch. You can see the love between them. Management receives a call from a family member, their eldest son, who says that John has had a heart attack and is in hospital in a critical state. This son, however, doesn’t wish to upset Martha and asks for the staff to make excuses about John not being able to come in and to not tell her what’s happened; at least until they know more about John’s condition. It is quite possible that John could die in hospital.•What are your reactions / thoughts? Discuss.

What about power?• Exploitative power: power that

destroys• Manipulative power: over the

other• Competitive power: against the

other• Nutrient power: for the other• Integrative power: with the other

Ethical practice / decision making

• Take the time, to talk / reflect (REA)• Slow down, avoid knee-jerk reactions and/or

decisions• Be mindful of problem solving approach• Seek to understand what assumptions and

interpretations are involved• Understand that there is often no simple

response – ethics is not, nor never will be, black and white

• Make visible your personal moral framework (create ethical maps – make your ethics visible)