Publications

ABSTRACT

Introduction: Hospice and palliative care is well recognized as the ideal model of care for the terminally ill. However, ethical issues are frequently encountered during the provision of palliative care. Data on ethical dilemmas faced by health care providers in palliative care settings in developing countries is scarce.

Objectives: To identify ethical dilemmas in the care of patients admitted in a palliative care unit in South India and factors related to these ethical dilemmas.

Methods: Qualitative data was collected by in-depth interviews of all the nurses involved in the care of terminally ill patients in a palliative care unit in rural Kerala from November 2013 to July 2014. The data was interpreted, coded and grouped into key domains before analysis.

Results: A total of seven in-depth interviews were conducted, which revealed a number of ethical dilemmas and challenges that the nurses encountered while providing palliative care. It was noted that patients' preferences and decisions were influenced by family members. Dilemmas were not faced while taking decisions regarding hydration and nutrition. There were ethical dilemmas with regards to the place of care, alternative treatment and therapeutic strategy.

Conclusion: This study identified ethical dilemmas with regards to place of care, alternative treatment and therapeutic strategy. Ethical issues in palliative care settings need to be addressed, with a possible role of institutional ethics committees to help in decision-making. Training in ethics for health professionals would assist in solving the ethical dilemmas in palliative care.