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Bioethical aspects of end-of-life care

Published online by Cambridge University Press:  01 February 2008

N. Zamperetti ,
R. Bellomo  and
C. Ronco
N. Zamperetti*
Affiliation:
San Bortolo Hospital, Department of Anesthesia and Intensive Care Medicine, Vicenza, Italy
R. Bellomo
Affiliation:
Austin & Repatriation Medical Center, Department of Intensive Care, Heidelberg, Victoria, Australia
C. Ronco
Affiliation:
San Bortolo Hospital, Department of Nephrology, Vicenza, Italy
*
Correspondance to: Nereo Zamperetti, Department of Anesthesia and Intensive Care Medicine, San Bortolo Hospital, Via Rodolfi, 37, 36100 Vicenza, Italy. E-mail: nereo.zamperetti@ulssvicenza.it; Tel: +39 0444 993895 (secretary), +39 0444 993862 (ICU); Fax: +39 0444 993895/927567
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Summary

Managing end-of-life care can be difficult because of the particular nature of intensive care support, which can separate the biological and the biographical aspects of life. Artificial organ support can temporarily delay death but, at the same time, may fail to restore a quality of life that the patient judges acceptable. For this reason, two concepts must be considered: that the mission of the healthcare system should be to care for patients according to their interests and wishes and that quality of care is related above all to the careful commitment of healthcare workers to the patient’s best interests. Keeping these concepts in mind, the rule of the five Cs (competence, collegiality, communication, continuity of care and compassion) might be helpful in the management of end-of-life care. Unfortunately, neither the rule of the five Cs nor the careful use of moral principles in order to promote the patients’ dignity can assure a universally acceptable decision. A reasonable level of ‘moral certainty’, however, might be achieved using a deliberative approach, which provides for the inclusion of all the different subjects involved in the decision-making process (patient, family, doctors, nurses and other carers), in order to reach the best possible decision in a specific situation.

Keywords

ETHICSMORAL OBLIGATIONSDECISION-MAKING
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue S42 , February 2008 , pp. 51 - 57
Copyright
Copyright © European Society of Anaesthesiology 2008

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