This document discusses several ethical principles related to terminal illness: respect for autonomy, beneficence, non-maleficence, and justice. It notes that physicians must obtain informed consent from competent patients before treatment, even if terminally ill. The principle of beneficence means doing good and helping patients through preserving life, restoring health, relieving suffering and maintaining function. Non-maleficence means avoiding harm. Justice means equitable distribution of medical resources. Ethical decisions in terminal illness are generally made on an individual basis considering these principles.

1. Ethical issues in terminal
illness
Dr. Zaid Al-Attar

2. Ethical Principles and Rules
• The principle of respect for autonomy
• The principle of beneficence
• The principle of non-maleficence
• The principle of justice

3. The Principle of Respect for Autonomy
Physicians do not have the right to treat patients without their consent:
Physicians must obtain informed consent from patients, even in the
terminally ill, before undertaking procedures. Five elements have been
proposed as the components of informed consent
• Competence
• Disclosure of information
• Understanding of information
• Voluntariness
• Authorization

4. The Issue of Futility
• While caring for terminally ill patients, physicians might be
confronted with the question of whether to continue a therapy
which they consider futile.
• a health-care professional has no obligation to offer, begin, or
maintain a treatment which, in his or her best judgment, will be
physiologically futile.

5. The Principle of Beneficence
The principle of beneficence simply
means the principle of doing good:
It encompasses the fundamental goals of
medicine which are:
• The preservation of life
• The restoration of health
• The relief of suffering
• The restoration or maintenance of
function

6. The Principle of Non-maleficence
• Nonmaleficence stands for avoiding anything that might have
negative consequences.

7. The Principle of Justice
Justice may be defined as giving
medical service to each person that
requires.
It is a matter of justice to ensure
equitable distribution of medical
resources to all citizens.
E.g. performing CPR although it is
inappropriate or futile might delay or
prevent emergency treatment in other
patients with a better chance of
survival.

8. General guidelines of ethics in terminal illness
1. Ethical decisions in terminal illness are generally made on an
individual basis.
2. On critical or palliative care units, an atmosphere of close clinical
supervision is usually found.
3. Treatment decisions can be communicated to the relatives, to all
members of the health care team, and sometimes to the patient.
4. Ethical conflicts in terminal illness are difficult to resolve and are
influenced by a wide variety of personal beliefs and religious and
cultural differences.
5. A detailed ethical analysis should be done of the specific case,
based on the knowledge of the relevant principles - respect for
autonomy, beneficence, nonmaleficence, and justice.