Caring for seriously ill and dying patients: the philosophy and ethics

The care of seriously ill and dying patients necessitates a philosophic and ethical basis, without which unacceptable patterns of practice may develop. Several problems are described: inadequate or unskilled communication of information, withdrawal by the physician, patient labelling and poor health care. Palliative care must be based on a philosophy that acknowledges the inherent worth and dignity of each person. In addition, it must take place within the framework of four ethical principles: autonomy, beneficience, nonmaleficience and justice. The first and most important of these is the need to regard patients as unique people with a right to compassion, gentle truth, autonomy in decision-making and excellence in physicial and psychospiritual care. Beneficence obliges us not only to relieve suffering but also to enhance the patient's quality of life whenever possible. Nonmaleficence and justice require allocation of sufficient health care resources of the type necessary to provide high-quality care and prevent patients from coming to harm.