An Ethical Framework for End-of-Life Discussions

The primary goal of medical care is to assist patients to address medical issues which may threaten their health in order to preserve and restore the quality of the patients’ life. However, when a patient’s prognosis for meaningful survival is poor, there is a change in focus from restorative care to palliative care. The transition from “cure to comfort” is one of the most challenging and important medical care decisions the patient and family may encounter. The purpose of this article is to help give patients, families and care-givers an ethical framework to effectively discuss treatment options, values, and preferences during the change from restorative care to palliative care. Having discussed the many obstacles which impede meaningful participation for end-of-life decision making, the focus of this article then turns to the ethical concerns which should undergird end-of-life decisions. Perhaps the most significant ethical consideration is not patient autonomy but the valuing the personhood of the patient. The main objective of end-of-life discussions should be to prepare patients and their families to work with the medical team to make the best possible “in-the-moment” care decisions. These discussions should focus on outcomes, not treatments. These expected outcomes should respect the personhood of the patient, their values and priorities. Our society has struggled for several decades to define appropriate end-of-life medical care which promotes life and does not simply prolong a person’s natural death. This article takes a step toward defining an ethical framework for effective end-of-life discussions