Primary care
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As palliative care emerges as a respected and important component of contemporary health care, ethical issues will arise that confront and contest the provision of medical care. The basic principles of medical ethics, embodied in beneficence, nonmaleficence, autonomy, and justice, guide primary care physicians in dealing with dying patients. This article will discuss the basic ethical principles and the principle of double effect, decision-making capacity, advance directives, withholding and withdrawing life-sustaining therapy, futility, artificial nutrition and hydration, do-not-resuscitate orders, and physician-assisted suicide and euthanasia.
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Palliative care is about total patient care, management of disabling and debilitating symptoms, and the role of the primary care physician. As physicians, we must understand who, what, when, how, and where to institute, or refer patients for palliative care. Who? Any patient needing assistance with the control of physical and nonphysical symptoms can benefit from palliative care. ⋯ How? The primary care physician makes the initial referral to the palliative care physician or team. Where? All hospices should have a palliative care physician or consultant. This article provides a broad overview of palliative care management and incurable illnesses.
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This article addresses advance directives and methods to establish the goals of care for remaining life in the decisional and nondecisional patient. Without these discussions, patient autonomy is negated, and the opportunity to provide patient-centered care using shared decision making is lost.
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Hospice and palliative care programs have grown rapidly in the United States over the last 25 years. Relief of suffering and maximization of quality of life including symptom control, psychosocial health, and spiritual care are the primary goals of hospice and palliative care. This article reviews the development, philosophy, and practice of hospice and palliative care, and describes barriers to and suggestions for integrating this approach into mainstream medicine.
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Grief and bereavement are frequent concerns of primary care physicians. This article outlines grief in terminally ill patients and discusses interventions. Also included in this article is a review of the process of anticipatory grief and mourning and a discussion on normal and complicated grief. A portion of this article also covers grief in children and discusses interventions for grieving children.