![]() ![]() seeking emergency care), or the place of care and death. In the trajectory of an incurable, progressive disease, patients and their FC are confronted with many difficult decisions influencing further care planning and quality of life, such as decisions about life-prolonging treatment, medically assisted nutrition and hydration, transitions in care (e.g. partners, relatives and friends who care for the patient, are a key resource for the well-being of terminally ill patients, but also by their assistance and active involvement in treatment decisions and care planning. ![]() Conclusionįindings provide first information towards understanding paths leading to ethical challenges in FC and can help clinicians to minimize associated emotional burden and moral distress.įamily caregivers (FC), e.g. Nevertheless, some FC experienced residual moral distress months after the morally troubling situation had occurred. In both paths, factors were identified that helped FC finding closure and prevented moral residue. While acceptance prevented moral distress, paralyzing shock often caused a sense of not meeting their their own moral expectations and values, resulting in moral distress. Either detrimental factors aggravated these feelings to paralyzing shock, or internal resources enabled FC to accept the situation. When no decision was to be made by FC (Path 2), FC felt powerless and overrun, which was associated with major emotionality in terms of anxiety and confusion. Decisions in conflict with FCs' own moral expectations and values led to moral distress, generating painful emotions. FC used various proactive strategies to overcome those detrimental factors and/or to make the decision. In the course of difficult decision-making (Path 1), detrimental external factors could add emotional stress, thus making the decision-making process burdensome. ![]() We found each path to be triggered by distinct sets of morally troubling situations that occurred during the patient’s disease trajectory. Ethical challenges occurred in the context of difficult decision-making (Path 1) and in the context of lacking decision-making options when no decision was to be made by FC (Path 2). ResultsĬore phenomena identified were two paths connected to ethical challenges among FC. Data were analysed using grounded theory and abductive reasoning. Within a qualitative design, interviews with 12 grieving FC were conducted using a semi-structured interview guide. The present study aims at tracing paths connected to ethical challenges among FC of advanced cancer patients by exploring morally troubling situations and related burden, as well as strategies to handle the situation and experience of moral distress from the grieving FC’s perspective. The physician has a moral imperative to assure good care for dying patients.Caring for patients with advanced or terminal diseases can confront family caregivers (FC) with ethical challenges. The integrity of the physician as a moral agent in the clinical setting needs to be recognized and honored. Physicians need to incorporate spiritual issues into the management of patients at the end of life. Physician-assisted suicide could negate the traditional patient-physician relationship and place vulnerable populations at risk. The physician should establish the basis for the request and work with the healthcare team to provide support and comfort for the patient. Physicians caring for terminally ill patients receive requests for physician-assisted suicide. Medical interventions, including artificial nutrition and hydration, can be withheld or withdrawn if this measure is consistent with the dying patient's wishes. Medical futility is difficult to identify in the clinical setting but may be described as an intervention that will not allow the intended goal of therapy to be achieved. Effective advance care planning can assure patient autonomy at the end of life even when the patient has lost decision-making capacity. ![]() Providing good care for dying patients requires that physicians be knowledgeable of ethical issues pertinent to end-of-life care. ![]()
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