improving end of life care in older people – the ethical perspective
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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 - PowerPoint PPT PresentationTRANSCRIPT
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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
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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
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Vulnerable
Dependent
Non-competent
Hospitalised
In which case we need to protect them, advocate for them, manage their care.
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DNAR notices
Whistle-blowing
Post –Shipman
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Feisty
Independent
Demanding
Well informed
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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.”
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Family
Church, Mosque, Community groups
Nursing home staff
No one
Loss – Spouse, Friends, GP
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Demystifying death and dying
Advance decisions
Proxies
Life Value Histories
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Final Chapter or Important transition
Spiritual experience or biological fact
Private or public event
Welcome , unexpected, tragic, appropriate
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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.
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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
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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
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Where do older people feature in this debate?
Where do older people feature in the evidence?
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A good death recognisable as such in the context of the person’s life and dying.
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Individualised Respectful Dignified Timely Acceptable