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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. - PowerPoint PPT Presentation
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Ethics of End of Life Care
Chan Tuck WaiB.Sc. (Pharmacy), MBACertified IRB Professional (USA)Human Protection AdministratorNational University Hospital, National University of Singapore
What do I want during my last 6 months?
A Healthy BirthA Happy LifeA Good Death
12 Principles of Good Death
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
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
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
Sufferings of EOL
Pain Sleep Breathing Metabolic Digestive Skin Emotional
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.”
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
Ethics Consideration
Respect Beneficence Non-Maleficence Justice
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
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
Thank You
Questions and Answers