BASIC PRINCIPLES

AND ETHICS IN
PALLIATIVE CARE
Eifel Faheri

Anatole Broyard

(literary editor

NYT)
To the typical physician, my illness is a
routine incident in his rounds while for
me it's the crisis of my life. I would feel
better if I had a doctor who at least
perceived this incongruity . . . I just wish
he would . . .give me his whole mind just
once, be
bonded with me for a brief space,
survey my soul as well as my flesh, to
get at my illness, for each man is ill in

 83 tahun, limfoma,epistaxis.
- PS
- Kemo atau tidak
- befenit dan risk
- pilihan terapi komunikasi
- 4 kali kemo gejala hilang
- tutup usia,dg stroke,tanpa nyeri,epistaksi

aki 73 tahun, dg Ca Colon, stadium

hati, aktif sebagai pengurus organ
moterapi 3 siklus, evaluasi, kemudian
o lanjutan efek samping berat,
utuskan tidak kemo. Kembali lagi 2 b
udian dg lebih sehat,tetap aktiif

INTRODUCTION
Palliative care development in
Indonesia is slow.
Not well developed in most
hospitals
Few specialist in palliative care
Not implementing integrated
system
Still need hardwork to build a good
team

The Public has Never Heard about Palliative Care

Consumer Awareness About Palliative Care:
How knowledgeable, if at all, are you about
palliative care?

Source: *Data from a Public Opinion Strategies national

survey of 800 adults age 18+ conducted June 5-8, 2011

Palliative Care

Reduces symptom burden

Improves patient and family
satisfaction
May increase survival
Reduces costs

Mortality Follow-back Survey:

Palliative Care vs. Usual Care
N=524 family survivors
Overall satisfaction markedly superior
in palliative
care group, p<.001

Palliative care superior for:

emotional/spiritual support
information/communication
care at time of death
access to services in community
well-being/dignity
Care and setting concordant with patient
Casarett et al. J Am Geriatr Soc 2008;56:593-99
preference

Problem contributing to suffering in

incurable disease

Pain
Nausea/Vomiting/ Anorexia
Breathlessness
Loss of social role/social isolation
Change of faith
Personality change
Depression
Sadness/ Denial/Anger
Fatigue/Anxiety
Financial difficult.

DEFINITION OF PALLIATIVE CARE

Palliative care is an integrated
system of care that improves
quality of life by providing pain
and symptoms relief , spiritual
and psychosocial support from
diagnosis to the end of life and
bereavement
(WHO 2005)

Palliative care aims

relief from pain and other

distressing symptoms
Affirming life and regarding dying
as a normal process
Intending neither to hasten nor to
postpone death
quality of life

Palliative care aims

(cont)
to put life into their days and
not just days into their life.
total care :
physical,social,phsycological and
spiritual.
Using a team approach .
individual specific

Palliative care aims (cont)

high touch, low tech
partnership
for open and sensitive
communication for all concerned

THE four Cardinal PRINCIPLES

No maleficient (do no harm)
Beneficence (do good)
Patient autonomy (patients right to be
informed and involved in decision making)
Justice (balanced

IMPLEMENTATION

Providing care
Hope
Enhancing dignity
Resilience

DEFINITION OF DIGNITY
A sense of being worthy of

esteem or respect
Sense of self worth
Sense of being burden to
others
How we are treated with
impact to self esteem and
self respect

Words To Avoid
He failed therapy
It would be futile to.
Theres nothing more to do
Hes not ready for palliative
care

Anatole Broyard literary editor NYT

To the typical physician, my illness is a

routine incident in his rounds while for
me it's the crisis of my life. I would feel
better if I had a doctor who at least
perceived this incongruity . . . I just wish
he would . . .give me his whole mind just
once, be
bonded with me for a brief space,
survey my soul as well as my flesh, to
get at my illness, for each man is ill in

A GOOD PHYSICIAN TREATS

THE DISEASE
BUT A GREAT PHYSICIAN
TREATS THE PATIENT THAT
HAS THE DISEASE

Sir William Osler

ETHICS IN PALLIATIVE
CARE

INTRODUCTION
Ethics plays an important role in
healthcare especially in hospice
and palliative care
Profoundly personal life and
death situations
Involving relationship in end of
life care
Sustained ethical environment
Heightening the excellence ,

IMPLEMENTATION
Internal

External

Patient and
Family
Employees and
volunteers
Governance
Other hospices
Donors
Public/Society

PATIENT AND FAMILY

Admissions
Care and services
Conflict of interesrt
Discontinuation of care
Information management ,
confidentiality and privacy

EMPLOYEES AND
VOLUNTEERS
Ensure that hospice and
palliative care employees
and voluneers are treated
with respect and fairness ,
while supporting their ability
to obtain the highest level of
skill and expertise in their
profession or role

GOVERNANCE
Adhere to governance
structure that ensure the
organization fulfill its mission
and purpose

OTHER HOSPICES
Work cooperatively with
other healthcare providers ,
supliers and payers to
provide compassionate and
competent end of life care

DONORS
Be open and transparent in
soliciting and accepting
financial support

SUMMARY
It is crucial to establish ethical
guidelines that will help to asses
the accountability
An Organization with clearly
articulated ethical principles and
a thorough commitment to those
principles is better positioned to
respond more effectively in times
of crisis .

THANK YOU