ABSTRACT
Decision-making at the end of life necessarily occurs within an ethical framework. Dying and death occur in a context of personal values and beliefs about suffering, the meaning of death, and the place of an individual within family and society. Palliative care promotes the importance of comfort and quality of life, and emphasises that the direction of care is determined by the individual concerned. However, the achievement of comfort and quality of life in association with patient-directed care often brings into focus differences in views between patients and practitioners regarding various practices. Questions can arise regarding such matters as the use of morphine, physician-assisted suicide, and terminal sedation. Although significant advances in clinical care mean that practitioners can now alleviate most physical suffering, their skills are challenged by a small proportion of patients who have intractable symptoms or significant existential distress. Caring for these people requires a sensitive appreciation of the ethical, legal, and moral perspectives of the patient, the family, and the clinical team. This requires an understanding of the context of suffering within which palliative care is often provided.
‘Palliative care promotes the importance of comfort and quality of life, and emphasises that the direction of care is determined by the individual concerned.’
