Asian Bioethics Review

A s i a n B i o e t h i c s R e v i e w S e p t e m b e r 2 0 0 9 Vo l u m e 1 , I s s u e 3 252 Factors Associated with Good Death G E M M A N . B A L E I N Background Several studies abroad have already explored the factors considered important at the end of life among terminally-ill patients, family members and healthcare providers. Results gathered ranged from “freedom from pain” (Christakis, 2005), “acceptance and closure, most often at home” (Steinhauser, 2000), “autonomy, control and independence” (The Future of Health and Care of Older People, 1999) to “proper medical care, sensitivity to the religious and spiritual values, and living well with God ” (Sheenan, 2000). However, the pre-eminence that Western culture places on the principle of autonomy at the end of life has often been challenged by the practices, beliefs and values of the Filipinos. Bioethics, therefore, needs to address, understand and practise its discipline in the Philippines according to the country’s norms and culture. Findings in this study can provide important clues on what death and dying issues bioethics needs to address in the Philippine context. Discussions centering on those extremely important factors at the end of life can help care institutions and ethics review boards provide better end of life care, thus, providing a humane, dignified and good death. Another significant feature of this study is defining what constitutes a good death by factors rated as extremely important by more than 70% of the respondents. This was based on a similar study which used the same criteria. More importantly, the setting of a huge margin of error is demanded by the fact that this study deals with end of life issues which greatly trouble patients, family members and even healthcare providers. Research Method and Design The descriptive cross-sectional design was the basis of the survey methodology used in this study. The variables are the factors associated with good death, as F I N D I N G S 252–258 Asian Bioethics Review September 2009 Volume 1, Issue 3 253 perceived by terminally-ill patients, family members, and healthcare providers, classified under seven domains: the first two, which fall under the bioethical principle of autonomy, are communication and informed decision-making, and advance care planning; the next five variables, which fall under the bioethical principle of beneficence, non-maleficence and justice, are physical comfort, medical and nursing care, social relationships and family support, spiritual support, and sense of emotional well-being. The study was conducted in the Supportive Palliative and Hospice Care Clinic and the Cancer Institute at the University of the Philippines-Philippine General Hospital. From June 2007 through August 2007, 35 terminally-ill patients were identified and approached for consent. Among the patients, all had at least one family member who would provide care for the patient in the hospital. After being approached for consent, 41 family members agreed to participate. Healthcare providers, directly involved in the care of the terminally-ill, were approached for consent and 34 decided to take part in the study. There were more female respondents than male. The mean age for patients and family members were 46.8 and 44.3 respectively. For healthcare providers, the mean age was 30 years. Except for the healthcare providers, the majority of the participants were married. Only the healthcare providers attained a high percentage of college graduates. A majority of the other groups attained grade school or high school education. Almost all participants were Roman Catholics and considered their faith and spirituality as very important. More than 60% of the respondents reported good health, while more than 50% did not consider themselves depressed. Many patient and family member respondents have not accompanied someone during the last hours of life. The instrument used in this study was a 35-item researcher modified questionnaire based on a survey toolkit made by Dr. James Tulsky (2000). Part I consisted of the profile of respondents of the study. Part II consisted of 35 close-ended questions in a Likert scale with statements...