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Improving end of life care in older people – the ethical perspective

Improving end of life care in older people – the ethical perspective. Professor Bobbie Farsides Professor of Clinical and Biomedical Ethics Brighton and Sussex Medical School. What can we say of old age?. In global terms it is a luxury

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Improving end of life care in older people – the ethical perspective

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  1. Improving end of life care in older people – the ethical perspective Professor Bobbie Farsides Professor of Clinical and Biomedical Ethics Brighton and Sussex Medical School

  2. What can we say of old age? • In global terms it is a luxury • In our own society it is something we have grown to expect, or at least realistically hope for • People are living longer, we have added years to life, but have we added life to years? • How does our culture treat elderly people? • We are tomorrow’s elderly are we prepared for this fact? • Elderly people are a ‘product’ of the context within which they age

  3. SOME older people are.... • Vulnerable • Dependent • Non-competent • Hospitalised • In which case we need to protect them, advocate for them, manage their care.

  4. Recent issues DNAR notices Whistle-blowing Post –Shipman

  5. Other older people are Feisty Independent Demanding Well informed

  6. ‘Nan’

  7. Diana Athill 2009 Costa Book Award (formerly the Whitbread Prize) for her autobiography Somewhere Towards the End (Granta). The judges called Athill’s book “a perfect memoir of old age – candid, detailed, charming, totally lacking in self-pity or sentimentality and above all, beautifully, beautifully written.”

  8. Significant Others Family Church, Mosque, Community groups Nursing home staff No one Loss – Spouse, Friends, GP

  9. Preparing for old age Demystifying death and dying Advance decisions Proxies Life Value Histories

  10. The end of life Final Chapter or Important transition Spiritual experience or biological fact Private or public event Welcome , unexpected, tragic, appropriate

  11. Lives worth living If you believe in the sanctity of human life all lives are of value irrespective of their quality If you do not hold this view you may believe that some lives are of such low quality they are not worth living.

  12. Should we seek to prolong life in all circumstances? Important ethical issue irrespective of age Age specific variants e.g. ‘fair innings arguments’ QUALYs Age neutral variants e.g. quality of life, futility, justice

  13. Withdrawing and Withholding Treatment Conservative management (renal dialysis) Patient choice to refuse treatment (a) due to burdensomeness of treatment (b) as an end of life decision Decisions made in the best interests of non-competent patients

  14. Assisted Dying Debate Where do older people feature in this debate? Where do older people feature in the evidence?

  15. The goal of end of life care A good death recognisable as such in the context of the person’s life and dying.

  16. Universal features Individualised Respectful Dignified Timely Acceptable

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