Ethical and Legal Issues in end-of-life care, presented by Prof Faisal Ghani for Farabi Medical College medical students.

1. ETHICAL AND LEGAL ISSUES
IN END-OF-LIFE CARE
PROF. FAISAL GHANI SIDDIQUI

2. Ethical dilemmas
for the end-of-life almost always involve
decisions to
WITHHOLD / WITHDRAW TREATMENT

3. WHEN THE
PATIENT AND DOCTOR AGREE
there is no benefit in carrying on or starting a new
intervention
THE RIGHT ACTION IS CLEAR . . . though skill
is required on the doctor's part to manage these
discussions sensitively

4. when patient requests to
continue or initiate a treatment
BUT . . . It is not in the benefit of the patient?
WHAT TO DO?

5. THERE ARE LIMITATIONS TO
PATIENT AUTONOMY
PATIENTS CANNOT DEMAND a treatment that
is not in their best interests and doctors need not
strive to preserve life

6. THE DOCTOR IS JUSTIFIED IN WITHHOLDING /
WITHDRAWING INTERVENTION WHEN;
• It is PATIENT'S DECISION to withhold a life-saving intervention
• HARMS OF TREATMENT outweigh any potential lengthening of
life
• the treatment will not achieve its SPECIFIED AIM
• It results in unnecessary / unequal distribution of RESOURCES
• Requires doctor to act AGAINST A PROFESSIONAL CODE OR
LAW

7. EXAMPLES OF
END-OF-LIFE TREATMENTS

8. 1
CLINICALLY-ASSISTED NUTRITION
AND HYDRATION

9. CLINICALLY ASSISTED NUTRITION AND
HYDRATION
• Hydration and nutrition is ESSENTIAL FOR HUMANS
• Families and doctors FIND IT DIFFICULT TO WITHDRAW
clinically assisted hydration and nutrition up to the end of life of
patient
• When nutrition and hydration become clinically-assisted, they
are CLASSED AS A TREATMENT rather than basic care
• Hence as treatment when they cease to offer overall benefit,
THEY CAN BE WITHDRAWN

10. 2
CARDIOPULMONARY
RESUCITATION

11. CARDIOPULMONARY RESUCITATION
• MAY FAIL TO RESTART THE HEART as patients
approach the end of their lives, or
• may result in a SHORT PERIOD of impaired quality of
life

12. Agreement should be reached among the
multidisciplinary team that
this is a FUTILE EXERCISE
And decision carefully recorded and conveyed

13. IN SUMMARY
• Patient autonomy has limits
• Doctor should be mindful of other responsibilities;
• To benefit and not harm the patient
• To use resources justly