Ethical issues in palliative care for patients with

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Ethical issues in palliative care for patients with M/XDR-TB Geneva, 19 November 2010 Palliative

Ethical issues in palliative care for patients with M/XDR-TB Geneva, 19 November 2010 Palliative Care and M/XDR-TB meeting Andreas Reis Department of Ethics, Equity, Trade and Human Rights Swiss Re – Pandemic Risk Talk

Relevance of the topic? in palliative care Palliative Care and M/XDR-TB Geneva, 19 November

Relevance of the topic? in palliative care Palliative Care and M/XDR-TB Geneva, 19 November 2010

Ethical issues related to palliative care • Justice • Autonomy • Professional responsibilities •

Ethical issues related to palliative care • Justice • Autonomy • Professional responsibilities • Cultural issues • Issues for further discussion Palliative Care and M/XDR-TB Geneva, 19 November 2010

Equitable Access to palliative care l Inequities of access between countries – Legal barriers

Equitable Access to palliative care l Inequities of access between countries – Legal barriers – Lack of resources l Inequities of access within countries – Socioeconomic factors – Stigma and discrimination address the needs of specific populations to the extent they represent barriers to care: e. g. HIV/TB treatment within IDU population: stigma, clinical management; children: misunderstandings regarding how children experience pain Palliative Care and M/XDR-TB Geneva, 19 November 2010

Patient autonomy Obtaining Valid Informed Consent: the role of patients & family in decision-making

Patient autonomy Obtaining Valid Informed Consent: the role of patients & family in decision-making l Need to establish a real possibility for the patient to participate in the decision making process, including the opportunity to modify his/her decision: – Adequate information given to patients – Possibility (time) to interact with health team – Families to be included where appropriate – culture-dependent l Need to establish special mechanisms for: – Evaluating the patient's autonomy to express his/her choice – Incompetent patients (e. g. children, persons with mental impairments) l Limits of autonomy? – potential risks to care-givers and community – shortening of life Palliative Care and M/XDR-TB Geneva, 19 November 2010

Professional Obligations – Patients have a right to sufficient pain control, and health care

Professional Obligations – Patients have a right to sufficient pain control, and health care workers have a professional duty to provide care, including palliative care – Health professionals have to be trained to: • Evaluate the patient's autonomy • Inform patients about treatment options and corresponding consequences in terms of risks and benefits • Use pain medication and other palliative treatments appropriately. • Be sensitive to cultural aspects. Palliative Care and M/XDR-TB Geneva, 19 November 2010

Cultural issues and barriers – Barriers in implementing palliative care can exist at the

Cultural issues and barriers – Barriers in implementing palliative care can exist at the level of the patient, the family, the community, the health professional, national regulation – Barriers in part stem from the diversity of ways of understanding fundamental concepts: e. g. dignity, individual rights, quality of life, harmony, etc. (in some cultural contexts suffering can "make sense") – Language barriers: expression and quantification of pain (cultural and psychological barriers), possibility to address the idea of death – Modalities for implementation of palliative care: home care/hospital, compatibility with religious or communitarian customs – So: Training has to address not only the lack of knowledge but also complexity of social and cultural issues Palliative Care and M/XDR-TB Geneva, 19 November 2010

Further issues for discussion - Potentially life-shortening interventions – Goal of actions: pain control/termination

Further issues for discussion - Potentially life-shortening interventions – Goal of actions: pain control/termination of life - Life sustaining interventions: futility of treatment - Assisted suicide Palliative Care and M/XDR-TB Geneva, 19 November 2010

Thank you very much! Contact: reisa@who. int Palliative Care and M/XDR-TB Geneva, 19 November

Thank you very much! Contact: [email protected] int Palliative Care and M/XDR-TB Geneva, 19 November 2010