The ethical decisions UK doctors make regarding advanced cancer patients at the end of life - the perceived (in) appropriateness of anticoagulation for venous thromboembolism: A qualitative study [Book Review]
David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Jack Alan Reynolds
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BMC Medical Ethics 13 (1):22- (2012)
Background: Cancer patients are at risk of developing blood clots in their veins - venous thromboembolism(VTE) - which often takes the form of a pulmonary embolism or deep vein thrombosis. Therisk increases with advanced disease. Evidence based treatment is low molecular weightheparin (LMWH) by daily subcutaneous injection. The aim of this research is to explore thebarriers for doctors in the UK when diagnosing and treating advanced cancer patients withVTE.MethodQualitative, in-depth interview study with 45 doctors (30 across Yorkshire, England and 15across South Wales). Doctors were from three specialties: oncology, palliative medicine andgeneral practice, with a mixture of senior and junior staff. Framework analysis was used. Results: Doctors opinions as to whether LMWH treatment was ethically appropriate for patients whowere symptomatic from VTE but at end of life existed on a shifting continuum, largelyinfluenced by patient prognosis. A lack of immediate benefit coupled with the discomfort of adaily injection had influenced some doctors not to prescribe LMWH. The point at whichLMWH injections should be stopped in patients at the end of life was ambiguous. Someperceived overcaution in their own and other clinicians treatment of patients. Viewpointswere divergent on whether dying of a PE was considered a "good way to go". Theinterventionalism and ethos of palliative medicine was discussed. Conclusions: Decisions are difficult for doctors to make regarding LMWH treatment for advanced cancerpatients with VTE. Treatment for this patient group is bounded to the doctors own moral andethical frameworks
|Keywords||Venous thromboembolism Heparin Low-molecular-weight Palliative care Qualitative research Ethics Medical|
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References found in this work BETA
D. Strech & J. Schildmann (2011). Quality of Ethical Guidelines and Ethical Content in Clinical Guidelines: The Example of End-of-Life Decision-Making. Journal of Medical Ethics 37 (7):390-396.
Osamu Muramoto (2011). Socially and Temporally Extended End-of-Life Decision-Making Process for Dementia Patients. Journal of Medical Ethics 37 (6):339-343.
Jan Schildmann, Julia Hoetzel, Anne Baumann, Christof Mueller-Busch & Jochen Vollmann (2011). Limitation of Treatment at the End of Life: An Empirical-Ethical Analysis Regarding the Practices of Physician Members of the German Society for Palliative Medicine. Journal of Medical Ethics 37 (6):327-332.
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