End-of-life practices: An ethical framework for clinicians

Area of Science:

• Medical Ethics
• End-of-Life Care
• Healthcare Professional Morality

Background:

• Many hospitalized patients die after decisions to forgo life-sustaining treatment or focus on comfort care.
• Healthcare professionals (HCPs) often experience uncertainty and moral distress due to ethical conflicts surrounding end-of-life decisions, particularly concerning the norm against causing death.
• Existing ethical norms present challenges for HCPs when managing end-of-life care scenarios.

Purpose of the Study:

• To propose a structured ethical framework to aid clinicians in understanding their ethical perspectives on end-of-life practices.
• To help HCPs better comprehend their own attitudes and intentions regarding lethal injections, withdrawal/withholding of life-sustaining therapies, and palliative sedation.
• To provide a tool for mitigating moral distress among HCPs by clarifying ethical viewpoints.

Main Methods:

• Development of a three-tiered ethical framework (Perspectives A, B, and C) to analyze end-of-life practices.
• Examination of four specific end-of-life practices: lethal injections, withdrawal of life-sustaining therapies, withholding of life-sustaining therapies, and palliative sedation.
• Analysis of moral permissibility based on intention, respect for persons, and consequences.

Main Results:

• Moral Perspective A (Absolutist): Prohibits any causal involvement in a patient's death.
• Moral Perspective B (Agential): Permits causal involvement in death if the HCP's intention is not to end life and respect for the person is maintained; allows three practices but not lethal injection.
• Moral Perspective C (Consequentialist): Permits all four practices if respect for persons is ensured, even if the intention is to hasten death.

Conclusions:

• The proposed ethical framework offers a structured approach for HCPs to understand their moral perspectives on end-of-life care.
• This framework can help HCPs navigate complex ethical decisions, potentially reducing moral distress.
• Understanding these perspectives is crucial for ethical practice and communication among HCPs, patients, and colleagues.