How to improve ethical decision-making in clinical practice? Practical models and guidelines

Background: Clinical practice in palliative care is characterized by the need of making ethico-clinical decisions, particularly at the end-of-life. End-of-life situations are situations in which a severe deterioration in health, due to the evolution of a disease or another cause, threatens the life of a person irreversibly in the near future, posing the need to make ethico-clinical decisions. Often, these decisions are difficult and challenging; the so-called “ethical challenges” emerge. Despite its ubiquity, there is no consensualized definition of this expression. Various terms are used interchangeably, e.g., “ethical challenges”, “ethical problems”, “ethical issues”, “ethical dilemmas”. Moreover, even though there is a wide range of ethical decisions that need to be made in palliative and end-of-life care, there is no unique model or guideline to help professionals and teams in making difficult and complex decisions. Aim: To explore practical models and guidelines that can be used in clinical contexts to improve ethical decision-making in palliative and end-of-life situations. Methods: This presentation is based on the work developed within project DELiCare: Decisions, Decision-making, and End-of-Life Care: Ethical Framework and Reasoning. The overall project, its objectives, methods, results, and implications will be presented in an integrated fashion, including the application of ethical decision-making models and guidelines to specific clinical cases. Results: End-of-life decisions are rooted in clinical, sociocultural, political, legal, economic, and ethical concerns. Several models and guidelines for ethical decision-making at the end-of-life coexist but are rarely used in clinical practice. These models and guidelines can be a relevant aid for healthcare professionals and teams. They can stimulate the debate around disputed and controversial issues, helping professionals to follow a well-informed and shared decision-making model in order to meet patients’ values, wishes and preferences. Conclusions: Decision-making processes underlying end-of-life decisions are influenced by and foster clinical, ethical, sociocultural, religious, political, legal, and economic concerns and debates. Healthcare professionals working in palliative and end-of-life care often perceive these decision-making processes as complex and challenging. The use of practical models and guidelines can enhance professionals and teams’ competencies and effectiveness in making ethico-clinical decisions at the end-of-life.