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Ethics in Biology, Engineering and Medicine: An International Journal
SJR: 0.123

ISSN Imprimir: 2151-805X
ISSN On-line: 2151-8068

Ethics in Biology, Engineering and Medicine: An International Journal

DOI: 10.1615/EthicsBiologyEngMed.2011003417
pages 45-69

Ethics of End-of-Life Care: The Need for Improved Communication among Physicians, Patients, and Families

D. Passigli
Department of Orthopaedic Surgery & Rehabilitation Medicine, SUNY Downstate Medical Center, USA
R. Sarkar
Department of Orthopaedic Surgery & Rehabilitation Medicine, SUNY Downstate Medical Center, USA
S. Paul
Department of Orthopaedic Surgery & Rehabilitation Medicine, SUNY Downstate Medical Center, USA
Pamela S. Saha
Department of Psychiatry, Department of Public Health, Clemson University, Clemson, SC 29634; and Department of Orthopaedic Surgery & Rehabilitation Medicine, SUNY Downstate Medical Center, 450 Clarkson Ave., Brooklyn, NY 11203
Subrata Saha
Affiliate Professor, Department of Restorative Dentistry Affiliate Instructor, Department of Oral and Maxillofacial Surgery School of Dentistry, University of Washington, Seattle, Washington 98195-6365, USA; Courtesy Professor, Department of Biomedical Engineering, Florida International University, Miami, Florida 33174, USA

RESUMO

Modern medicine and public health initiatives in the United States have produced positive widespread changes in the health and longevity of its citizens. However, for many patients, these advancements have resulted in a longer but decreased quality of life. Other important effects include increased emotional burden on the family and higher financial costs on the healthcare system. Important ethical questions of futility and of patient autonomy have been brought to the forefront of end-of-life care. These questions have sparked a widespread debate as to when life-support treatments should be performed. Previous research has shown that even with increasing demands of patient autonomy, informed consent, and communication among physician, patient, and family, communication was limited or sometimes occurred only in an emergency. In this paper we provide a background on the ethical principles of beneficence and non-maleficence, discuss death and dying, and present a concise history of cardiopulmonary resuscitation (CPR) and do-not-resuscitate (DNR) orders. Furthermore, we identify the key communication gaps between physicians and patients/surrogates with respect to end-of-life care and decision making, and we also provide suggestions for ways in which these gaps can be reduced. The communication gaps among physicians, patients, and/or surrogates with respect to advanced directives (ADs), DNR orders, and end-of-life care need to be minimized with appropriate, realistic goals, detailed treatment planning, minimal medical paternalism, and communication that involves the least amount of vague or ambiguous language. By clarifying decisions on end-of-life care, resources can be better managed, resulting in decreased pain and suffering of the patient and family.