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Ethical Issues - End of life decisions

Introduction

Decisions about medical treatment that have consequences for the timing and nature of a person’s death engender strong emotions in both health professionals and the public and raise difficult ethical issues for all concerned. They can often be a source of conflict between health professionals and patients’ families, or between health professionals within a health care team. Ethical dilemmas arise when there is a perceived conflicting duty to the patient, such as a conflict between a duty to preserve life and a duty to act in a patient’s best interests, or when an ethical principle such as respect for autonomy conflicts with a duty not to harm. Decisions at the end of life are among the most frequently discussed issues in a clinical ethics committee, in the context of both individual cases and in determining Trust policy. In this section we provide a brief overview of the ethical and legal approaches to end of life decisions and then look at some specific issues that may be brought to committees by clinicians. We illustrate these with some hypothetical cases. The section concludes with some suggested further reading on the issues.

This section does not provide a comprehensive overview of the issues around end of life decisions, and does not make recommendations about what an ethics committee should do. It highlights issues that a committee may wish to consider and provides some ethical and legal frameworks for approaching the subject.