Palliative Care and Ethics

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October 20 is Global Ethics Day.

I did not know that such a day existed and came upon it mentioned in an email from our auditors.

As I am someone for whom ethics is very important and I also conduct training in ethics for those who are participating in the Introduction to Palliative Care Course, I was pleased with my discovery. Having found that such a day exists, I thought to put a few words down on my thoughts on Ethics in Palliative Care.

Some of the big ethical issues that often arise in Palliative Care surround end of life discussions, suicide and euthanasia. Does the ‘Right to Life’ presuppose the ‘Right to Death.’ I will avoid such discussions in this article and simply say that within the Hospice context we do not support or encourage euthanasia.

However, it is seldom the big ethical issues that we encounter on a daily basis. It is more frequently issues that arise from patient to patient (or family to family) and have little value outside of that particular patient. For this reason alone, it makes these issues and questions vitally important for the nurses, social workers and care givers who interact with our patients on a regular basis.

I wish to speak a little about James (not his real name) who is a new patient at Msunduzi Hospice. James has oral cancer at a stage 4. He is 58 years old. James lives in dire poverty in a shack. James has a number of issues that complicate his care which can not be mentioned in order to maintain his anonymity. However, James’ main issue is accommodation and placement. Because he has no ID finding a place for James to stay is virtually impossible. Obtaining ID’s lies beyond the ability of Msunduzi Hospice and while we may advise on what needs to be done in order to obtain an ID, we can not do this on our patient’s behalf.

What are some of the ethical issues that our team face. The main issue is placement. I recall a statement by one of my ethics professors when I was studying, “An ‘ought’ implies a ‘can.’” If we ought to do something there is an implication that we can do something. If we can’t do it then there is no ‘ought.’ However, with regards to James’s placement there is nothing we can do until such time as the ID is resolved. So ought we to be trying to find placement for James? The short answer, for now, is ‘no’, at least until the ID matter is resolved.

This is one little ethical issue that our team came across in the last few days. There are many that are similar. The value of including ethical awareness when we provide Palliative Care training is that some of these issues can be readily resolved (at least from an ethical point of view). The emotional impact is another matter all together. The ethical input when we provide Palliative Care training focuses on the basic ethical principles – benevolence, non-maleficence, justice and autonomy. But we also look at some ethical values such as care, compassion and similar values. Many of which, motivate and support the caring profession, in particular those who work within the Palliative/Hospice Care movement. By brining ethics into our everyday discussions and decision making, we make ethics real and part of our lives. This is the value of (even basic) ethics instruction for those who practice Palliative Care. It an essential value for all who serve in the Hospice/Palliative Care movement.

By way of conclusion, in the case of James mentioned above. Our social workers have managed to find a contact within the local Hospital where James is receiving medical attention that will help him obtain his ID document. At this stage we are not sure how long this will take. However, once James has his ID, then the ‘ought’ referred to above is a possibility for our team and we will try to find James a place to stay until he dies. This means that at least he will die with some dignity.

Created by Carnegie Council for Ethics in International Affairs, Global Ethics Day is an annual moment to empower ethics through the actions of individuals and organizations. The theme this year is ‘Ethics Empowered.’ For more information please see the following website: www.globalethicsday.org

By Warren Oxford-Huggett

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