Transcript I know that the spiritual work is of paramount importance and while it

Reflecting on the Ethics
of End of Life Care
Dr Monika Wilson
ReConnections Counselling Service
www.reconnectionscounselling.com
• To deepen our understandings of what
constitutes end of life care ethics
• To consider the ethics of our practice and what
frameworks of understanding we bring to our
work
• To develop greater awareness of what
assumptions and interpretations we bring to the
ethics of our practice
• To construct ethical maps by which to guide our
practice
•What is end of
life care ethics?
• Creating and sustaining relationships
which mutually recognise the needs,
interests and aspirations of all
participants as ‘ends in themselves’. The
focus is on the continuing enhancing of
the other and the self within the human
social condition as it is actualised within
specific situations, roles, practices,
institutions and cultures. In short,
applied ethics seeks to enhance the
ethical form of life (Isaacs & Massey, 1994).
What guides you?
• Invisible moral framework
(compass)
• Ethical articulation: is the
process whereby the ‘tacit
background’ or what is
unsaid about the ethical
domain is expressed and
acknowledged
Sources of morals/ethics
• Organisational
(written/unwritten)
• Family traditions
• Personal values
• Professional codes
• Covenantal
relationship with
community
• Religious or spiritual
beliefs
• Cultural influence
Guide to Ethical Conduct
In accordance with our expertise and in the context of our relationship to
residents we commit ourselves to protect the following rights of our
residents:
1. the right of individuals to be treated with respect;
2. the rights of the individual to life, liberty, and security;
3. the right of individuals to have their religious and cultural identity
respected;
4. the right of competent individuals to self-determination;
5. the right to an appropriate standard of care to meet individual needs;
6. the right to privacy and confidentiality;
7. the recognition that human beings are social beings with social needs.
And we will protect these rights no matter how frail, physically or mentally
disabled, or financially, socially or psychologically vulnerable, the resident
may be (Guide to Ethical Conduct for Providers of Residential Aged Care, DoHA, 2012)
Code of Ethics for Nurses
• Nurses value quality
nursing care for all
people
• Nurses value respect
and kindness for self and
others
• Nurses value the
diversity of people
• Nurses value access to
quality nursing and
health care for all
people
(ANMC)
• Nurses value informed
decision making
• Nurses value a culture of
safety in nursing and
health care
• Nurses value ethical
management of
information
• Nurses value a socially,
economically and
ecologically sustainable
environment promoting
health and wellbeing
Video: In the End
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What ethical principles did you notice?
What values did you notice?
What reactions did you have?
Who did you most resonate with?
You have been caring for Martha now for nearly a year.
She has advanced Parkinson’s Disease. You have
grown quite fond of her. Her husband, John, comes in
everyday to sit with her and have lunch. You can see
the love between them.
Management receives a call from a family member,
their eldest son, who says that John has had a heart
attack and is in hospital in a critical state. This son,
however, doesn’t wish to upset Martha and asks for the
staff to make excuses about John not being able to
come in and to not tell her what’s happened; at least
until they know more about John’s condition. It is quite
possible that John could die in hospital.
• What are your reactions / thoughts? Discuss.
What about power?
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Exploitative power: power that destroys
Manipulative power: over the other
Competitive power: against the other
Nutrient power: for the other
Integrative power: with the other
Ethical practice / decision making
• Take the time, to talk / reflect (REA)
• Slow down, avoid knee-jerk reactions and/or
decisions
• Be mindful of problem solving approach
• Seek to understand what assumptions and
interpretations are involved
• Understand that there is often no simple
response – ethics is not, nor never will be, black
and white
• Make visible your personal moral framework
(create ethical maps – make your ethics visible)