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Ethics of End of Life Care

Ethics of End of Life Care. Chan Tuck Wai B.Sc. (Pharmacy), MBA Certified IRB Professional (USA) Human Protection Administrator National University Hospital, National University of Singapore. What do I want during my last 6 months?. A Healthy Birth A Happy Life A Good Death.

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Ethics of End of Life Care

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  1. Ethics of End of Life Care Chan Tuck Wai B.Sc. (Pharmacy), MBA Certified IRB Professional (USA) Human Protection Administrator National University Hospital, National University of Singapore

  2. What do I want during my last 6 months? A Healthy Birth A Happy Life A Good Death

  3. Understand Death Retain Control Dignity and Privacy Control Pain Place of Death Access to Info, Experts Spiritual Support Hospice Care Who will share my end Advance Directives Time to say Goodbye No prolongation of suffering 12 Principles of Good Death

  4. The Truth • There is a major mismatch between people’s preferences for where they should die and their actual place of death • Most would probably like to die at home • Only around 18% do so with a further 17% in care homes • Acute hospitals accounting for 58% of all deaths • Around 4% in hospices • Only around one third of general public have discussed death and dying with anyone

  5. What is EOL care? • Key domain of Care • Physical • Psychological • Social • Spiritual • Key aspect of Care • Symptoms Control • Comfort measures • Anticipatory prescribing of medication • Discontinuation of inappropriate interventions • Psychological and spiritual care • Care of the family

  6. Sufferings of EOL Pain Sleep Breathing Metabolic Digestive Skin Emotional

  7. Kubler-Ross model on EOL patients • Denial –“I feel fine, This can’t be happening, not to me.” • Anger –“Why me? It’s not fair! Who is to blame?” • Bargaining – “Just let me live to see my children graduate” • Depression – “Why bother with anything? What’s the point?” • Acceptance – “I am going to ok, I Can’t fight it, I may as well prepare for it.”

  8. Improve Quality of Life • Symptomatic relief • Adding life to days and not days to life • First DO not Harm • Treatment should not be a burden • QOL improves despite not finding CURE • End point is Death

  9. Ethics Consideration • Respect • Beneficence • Non-Maleficence • Justice

  10. Respect is most Important • Respect for patients • Respect for family • Voluntary Informed Consent • Every treatment must be explained and accepted by the patient and family • Role of family in patient care

  11. Communication is crucial • Communicate regularly with patients and care givers • Communicate with previously consulted practitioners to obtain patient’s medical history and emotional state of mind • Must learn to LET GO

  12. Thank You Questions and Answers

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