Bioethical principles in the clinical practice of terminally ill patients in palliative care constitute a very important role in decision-making. One of the objectives imposed in this practice is to maintain trust and adequate communication with the patient.
To make decisions in the final stage of life, it is important to incorporate the basic principles of medical bioethics: beneficence, non-maleficence, autonomy and justice. Once these principles are taken, the decisions will be oriented to best practice.
Currently, the essence of the doctor-patient relationship has been lost, but by applying bioethics and health law, maintaining clear communication with a close bond with patients and family, timely decision-making will be achieved. The cornerstone of the relationship is good communication and anticipated will.
Doctors and healthcare personnel who provide end-of-life care to patients continually face ethical dilemmas. Good care requires, in addition to scientific knowledge, empathy and knowing the ethical dilemmas you may face, as well as knowing strategies to avoid conflicts. Good communication is necessary to give the patient the necessary elements for decision making, and to avoid futile medical acts.
Medical bioethics is a field of study that is focused on the decision-making process in the hospital setting, in which patients and their families face difficult decisions regarding their disease and treatment. Decisions may involve moral values, religious beliefs, and be influenced by the medical act and established guidelines.
Bioethics courses for professionals offer ways to identify and weigh the different values at risk so that the individuals responsible for decision-making can choose the best option after counseling. There are circumstances in which the best option for a certain patient is not clear, or when there are no agreements regarding the different options.
Bioethics online course provides principles that guide doctors and other health professionals in their activities and decision-making. Laws are not established around medical ethics, but guidelines or principles.
- Beneficence: It consists of doing good, seeking the greatest benefit of the patient in the physical, psychological and social aspects.
- Non-maleficiency: Consider minimizing or not harming the patient. None of the doctor’s actions or words should harm the patient physically, psychologically, or socially.
- Autonomy: It recognizes the ability and rights of all people to make their own decisions. It refers to respect for the autonomy and self-determination of human beings, through the recognition of their dignity and freedom. Respect for people is expressed in the informed consent process.
- Justice: It refers to the equitable distribution of the resources of attention according to the needs without considering social class, economic solvency, creed or color.
Difficult decisions
The management of a terminally ill patient is complex from a medical and ethical point of view. For example, for the use of antibiotics, it is necessary to consider whether the patient is in agony, whether antibiotics will prolong agony should not be administered; however, if the use of antibiotics could control symptoms such as fever or delirium they should be administered.
Another frequent question is the indication of parenteral nutrition, in which it should be considered whether it would improve the quality of life. It is also important to provide information to the patient and family regarding the complex mechanisms involved in weight loss and cachexia in cancer, emphasizing that this process does not respond to enteral or parenteral feeding; therefore, it is considered a futile and expensive treatment. In patients with gastrointestinal malignancies that are not in the end stage, feeding via nasogastric tube or gastrostomy is justified.
To suspend or not to implement a treatment to maintain the patient’s life is a frequent question in terminally ill patients. It is important to consider the risks and benefits of the different management that can be given to a certain patient.