Patients Near the End of Life
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Making Decisions Near the End of Life
Informed adults with decision–making capacity almost always have the legal and ethical right to refuse any recommended life–sustaining medical treatment. The patient has this right regardless of whether he or she is terminally or irreversibly ill, has dependents or is pregnant. Many patients, particularly those with terminal or irreversible illness, elect to forgo certain treatments or pursue treatments that their physicians may consider unwise. These situations demand empathy, thoughtful exploration of all possibilities, negotiation or compromise and may require time–limited trials and additional consultations. In the unusual circumstance that no evidence shows that a specific treatment desired by the patient will provide any benefit from any perspective, the physician need not provide such treatment. If the physician and patient cannot agree on how to proceed, there is no easy, automatic solution. Timely transfer of care to another care provider who is willing to pursue the patient’s preference may resolve the problem. Consultation with an ethics committee may be helpful.
Care of Patients Near the End of Life
End–of–life care is an important aspect of medical practice. Individual physicians and the medical community must be committed to the compassionate and competent provision of care to dying patients and their families. Patients rightfully expect their physicians to care for them and provide them medical assistance as they are dying. Good symptom control, ongoing involvement with the patient, physical, psychological and spiritual support are the hallmarks of quality end–of–life care. Care of patients near the end of life, however, has a moral, psychological and interpersonal intensity that distinguishes it from most other clinical encounters.
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