Ethical Aspects of End-of-Life Care and End-Stage Disease: A Review Article

Document Type : Review Article

Authors

1 PhD Student, Department of Law, Arak Branch, Islamic Azad University, Arak, Iran

2 Community Medicine Specialist, Cancer Prevention Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

3 Associate Professor, Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background: End of Life Care (EOL) and End-Stage Patients Care (ED) is usually presented in an environment full of a variety of emotional and moral challenges, the recognition of them can improve the quality of EOL services.Methods: In this narrative review, ethical aspects of EOL sucs as diagnosing the time of death or the final stage of the disease, patient's autonomy, the use of life sustaining treatments, and assisted dying were reviewed in 8 databases and 45 sources.Findings: Uncertainty is a principle in determining the proximity of the death or the final stage of a disease. In EOL, autonomy is limited, and some consider other moral principles, such as beneficence and justice, to be more important. Withholding of life sustaining treatments, especially in our country, is more moral and religious acceptance than withdrawing it. Approach medically assisted dying varies in different nations, and there are various moral justifications for accepting or denying it.Conclusion: Ethical issues in EOL are complex in nature, and are intertwined with individual attitudes, religious beliefs, and social conditions. Proper communication between the patient, family members, and clinicians is the most important factor in preventing and resolving EOL challenges.

Keywords


  1. Australian Commission on Safety and Quality in Health Care. National Consensus Statement: Essential elements for safe and high-quality end-of-life care. Sydney, Australia: ACSQHC; 2015.
  2. Izumi S, Nagae H, Sakurai C, Imamura E. Defining end-of-life care from perspectives of nursing ethics. Nurs Ethics 2012; 19(5): 608-18.
  3. Chapman L, Ellershaw J. Care in the last hours and days of life. Medicine 2015; 43(12): 736-9.
  4. Breslin JM, MacRae SK, Bell J, Singer PA. Top 10 health care ethics challenges facing the public: views of Toronto bioethicists. BMC Med Ethics 2005; 6: E5.
  5. Oberle K, Hughes D. Doctors' and nurses' perceptions of ethical problems in end-of-life decisions. J Adv Nurs 2001; 33(6): 707-15.
  6. Kazemi A, Kazemi M, Abbasi M, Kiyani M, Feyzollahi N, Ataloo S, et al. Assessing end of life support. Iran J Med Ethics Hist Med 2012; 5(2): 45-57. [In Persian].
  7. Chakraborty R, El-Jawahri AR, Litzow MR, Syrjala KL, Parnes AD, Hashmi SK. A systematic review of religious beliefs about major end-of-life issues in the five major world religions. Palliat Support Care 2017; 15(5): 609-22.
  8. Brown CE, Engelberg RA, Sharma R, Downey L, Fausto JA, Sibley J, et al. Race/Ethnicity, Socioeconomic Status, and Healthcare Intensity at the End of Life. J Palliat Med 2018; 21(9): 1308-16.
  9. Crawley LM. Racial, cultural, and ethnic factors influencing end-of-life care. J Palliat Med 2005; 8(Suppl 1): S58-S69.
  10. Kwak J, Haley WE. Current research findings on end-of-life decision making among racially or ethnically diverse groups. Gerontologist 2005; 45(5): 634-41.
  11. Kennedy C, Brooks-Young P, Brunton GC, Larkin P, Connolly M, Wilde-Larsson B, et al. Diagnosing dying: an integrative literature review. BMJ Support Palliat Care 2014; 4(3): 263-70.
  12. Hillman K, Chen J. Conflict resolution in end of life treatment decisions: A rapid review. Sydney, Australia: Sax Institute for the NSW, Department of Health; 2008.
  13. Taylor P, Dowding D, Johnson M. Clinical decision making in the recognition of dying: A qualitative interview study. BMC Palliat Care 2017; 16(1): 11.
  14. Sopcheck J. Social, economic, and political issues affecting end-of-life care. Policy Polit Nurs Pract 2016; 17(1): 32-42.
  15. van der Heide A, Deliens L, Faisst K, Nilstun T, Norup M, Paci E, et al. End-of-life decision-making in six European countries: Descriptive study. Lancet 2003; 362(9381): 345-50.
  16. Department of Medical Ethics, Tehran University of Medical Sciences. National ethical guidelines in palliative supportive care in end of life patients. Tehran, Iran: Ministry of Health and Medical Education; 2019. [In Persian].
  17. Zahedi F, Larijani B, Tavakkoly Bazzaz J. End of life ethical issues and islamic views. Iran J Allergy Asthma Immunol 2006; 6(Suppl 5): 5-15.
  18. Mobasher M, Aramesh K, Zahedi F, Nakhaee N, Tahmasebi M, Larijani B. End-of-life care ethical decision-making: Shiite scholars' views. J Med Ethics Hist Med 2014; 7: 2.
  19. Sharp S, Carr D, Macdonald C. Religion and end-of-life treatment preferences: Assessing the effects of religious denomination and beliefs. Soc Forces 2012; 91(1): 275-98.
  20. White B, Willmott L, Cartwright C, Parker M, Williams G. Key findings - Withholding and withdrawing life-sustaining medical treatment from adults who lack capacity: The role of law in medical practice. St Lucia, Australia: The University of Queensland; 2018.
  21. Choi K. Legal and ethical issues regarding end-of-life care in Korea. Dev Soc 2016; 45(1): 151-64.
  22. Karnik S, Kanekar A. Ethical issues surrounding end-of-life care: A narrative review. Healthcare (Basel) 2016; 4(2):
  23. Houska A, Loucka M. Patients' autonomy at the end of life: A critical review. J Pain Symptom Manage 2019; 57(4): 835-45.
  24. Pope TM. Certified patient decision aids: solving persistent problems with informed consent law. J Law Med Ethics 2017; 45(1): 12-40.
  25. Yavari N, Parsapoor A. The domain of autonomy, limitations and solutions. Iran J Med Ethics Hist Med 2017; 10(1): 182-97. [In Persian].
  26. Parsapoor A, Bagheri A, Larijani B. Patient's rights charter in Iran. Acta Med Iran 52(1):24-28.
  27. Yadav K, Gabler N, Cooney E, Kent S, Kim J, Herbst N, et al. Approximately one in three us adults completes any type of advance directive for end-of-life care. Health Aff 2017; 36: 1244-51.
  28. Yadav KN, Gabler NB, Cooney E, Kent S, Kim J, Herbst N, et al. Approximately one in three US adults completes any type of advance directive for end-of-life care. Health Aff (Millwood) 2017; 36(7): 1244-51.
  29. Mashayekhi J, Madani M, Saeedi Tehrani S. Ethical considerations on advance directives: An overview of the ethical and legal aspects in the context of Islamic teachings. Iran J Med Ethics Hist Med 2015; 8(3): 15-26. [In Persian].
  30. Jain G, Sahni SP. Euthanasia: A review on worldwide legal status and public opinion. Criminology and Criminal Law Review 2018; 1: 63-76.
  31. Pesut B, Greig M, Thorne S, Storch J, Burgess M, Tishelman C, et al. Nursing and euthanasia: A narrative review of the nursing ethics literature. Nurs Ethics 2020; 27(1): 152-67.
  32. Rodrigues P, Crokaert J, Gastmans C. Palliative sedation for existential suffering: A systematic review of argument-based ethics literature. J Pain Symptom Manage 2018; 55(6): 1577-90.
  33. Joodaki B, Sadeghi M, Ghani K, Mirzaie M. Physician-assisted suicide: ethical, jurisprudence and legal issues. Iran J Med Ethics Hist Med 2016; 9(4): 14-29. [In Persian].
  34. Salimi E, Fathi M J. A legal analysis of euthanasia in the Islamic criminal code of 2011. Iran J Med Ethics Hist Med 2013; 6(4):17-28. [In Persian].
  35. Mirmohamad Sadeghi H, Izadyar A. Physician assisted suicide: from foundations of criminalization to penal reaction. Med Law 2015; 9(32): 161-205. [In Persian].
  36. Menezes MS, Figueiredo MDGM. The role of end-of-life palliative sedation: Medical and ethical aspects - Review. Rev Bras Anestesiol 2019; 69(1): 72-7.
  37. Clarke G, Johnston S, Corrie P, Kuhn I, Barclay S. Withdrawal of anticancer therapy in advanced disease: A systematic literature review. BMC Cancer 2015; 15: 892.
  38. Hayes C. Ethics in end-of-life care. J Hosp Palliat Nurs 2004; 6(1): 36-43.
  39. McGee A, Truog RD. Withholding and withdrawing life-sustaining treatment and the relevance of the killing versus letting die distinction. Am J Bioeth 2019; 19(3): 34-6.
  40. Abu-El-Noor N, Abu-El-Noor M. End of life-decisions: An Islamic perspective. Online Journal of Health Ethics 2014; 10(1): 4.