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Ethical dilemmas in palliative care: a study in Taiwan.

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Affiliations

  • 1. National Taiwan University Hospital, Taipei, Taiwan.
      Authors
    • Chiu TY 1
    (1 author)

ORCIDs linked to this article

Journal of Medical Ethics, 01 Oct 2000, 26(5):353-357
https://doi.org/10.1136/jme.26.5.353 PMID: 11055038 PMCID: PMC1733275

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Abstract 

Objectives

To investigate the incidence and solution of ethical dilemmas in a palliative care unit.

Design

Health care workers recorded daily all dilemmas in caring for each patient.

Setting

Palliative care unit of National Taiwan University Hospital in Taiwan.

Patients

Two hundred and forty-six consecutive patients with terminal cancer during 1997-8.

Main measurement

Ethical dilemmas in the questionnaire were categorised as follows: telling the truth; place of care; therapeutic strategy; hydration and nutrition; blood transfusion; alternative treatment; terminal sedation; use of medication, and others.

Results

The type and frequency of ethical dilemmas encountered were: place of care (33.3%); truth-telling (32.1%); hydration and nutrition (25.2%); therapeutic strategy (24.8%), and use of medication (19.1%). Ethical problems relating to the place of care and to therapeutic strategy were unlikely to be solved with increased hospital stay and some ethical dilemmas remained unsolved even in the final week in hospital, including place of care (23.2%), truth-telling (17.1%) and therapeutic strategy (11.4%). Problems of truth-telling occurred in nearly half (42.6%) of patients over sixty-five-years-old. Conflicts about blood transfusion were experienced in all patients below 18-years-old, and the dilemmas concerning the place of care occurred most frequently with head and neck cancer patients (43.8%).

Conclusions

The solution of ethical dilemmas required refocusing by medical professionals on the importance of continuing communication. Improved ethical training for professionals would contribute to solving the moral dilemmas of palliative care.

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Logo of jmedethLink to Publisher's site
J Med Ethics. 2000 Oct; 26(5): 353–357.
PMCID: PMC1733275
PMID: 11055038

Ethical dilemmas in palliative care: a study in Taiwan

T. Chiu, W. Hu, S. Cheng, and C. Chen
Author information Copyright and License information Disclaimer

Abstract

Objectives—To investigate the incidence and solution of ethical dilemmas in a palliative care unit.

Design—Health care workers recorded daily all dilemmas in caring for each patient.

Setting—Palliative care unit of National Taiwan University Hospital in Taiwan.

Patients—Two hundred and forty-six consecutive patients with terminal cancer during 1997-8.

Main measurement—Ethical dilemmas in the questionnaire were categorised as follows: telling the truth; place of care; therapeutic strategy; hydration and nutrition; blood transfusion; alternative treatment; terminal sedation; use of medication, and others.

Results—The type and frequency of ethical dilemmas encountered were: place of care (33.3%); truth-telling (32.1%); hydration and nutrition (25.2%); therapeutic strategy (24.8%), and use of medication (19.1%). Ethical problems relating to the place of care and to therapeutic strategy were unlikely to be solved with increased hospital stay and some ethical dilemmas remained unsolved even in the final week in hospital, including place of care (23.2%), truth-telling (17.1%) and therapeutic strategy (11.4%). Problems of truth-telling occurred in nearly half (42.6%) of patients over sixty-five-years-old. Conflicts about blood transfusion were experienced in all patients below 18-years-old, and the dilemmas concerning the place of care occurred most frequently with head and neck cancer patients (43.8%).

Conclusions—The solution of ethical dilemmas required refocusing by medical professionals on the importance of continuing communication. Improved ethical training for professionals would contribute to solving the moral dilemmas of palliative care.

Key Words: Palliative care • terminal care • ethical dilemma

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
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