11 - Ageing and end of life decisions

Summary

This chapter explores the interplay of values and teamwork in end of life care.

There are many big ethical dilemmas about end of life and palliative care. As the population of many countries ages, euthanasia is a topic that is constantly in the media, while conditions in the UK's aged care and nursing facilities are undergoing much scrutiny. Elderly patients and clients are frequently cared for by teams of professionals, whose individual members may have different values relating to prolonging life or hastening death. The team caring for a dying patient is hoping to provide a ‘good death’ and members may become emotional and vulnerable. Any existing team dysfunction may be magnified at such emotive times.

As we age, we begin to consider what our future holds. We value the right to die with dignity while realising that, while we may be fortunate and die in the place of our choosing, we are unlikely to be able to choose the time or manner. Health professionals share this ultimate experience with all their patients as we are all aware we are going to die, and therefore we may expect that we can empathise with the emotions that such knowledge brings. here may be denial, fear, acceptance, readiness, happiness, sadness, anger, powerlessness. As with other areas we have explored, professionals have personal and professional values, that may be conflicting, that may conflict with others in their team, that may conflict with the patient’s and their family’s. More people are considering whether it is their right to choose a time, manner and place of death. Some British citizens exercise that choice by travelling to Switzerland to die with Dignitas, while in the Netherlands euthanasia is sanctioned by the state, under strict conditions. While we may rarely have to grapple with major ethical issues, day-to-day discussions about life and death are influenced by values amongst the team and held by patients.