Dying with Dignity

Fig. 9.1

The six steps of the National End of Life Care Pathway (Reprinted courtesy of the Department of Health, England)

Algorithms that have a focus on a particular aspect of end-of-life care have been proposed. An example algorithm has been proposed (Szalados 2007) which approaches the issues from an ethical and legal perspective but provides a practical step-by-step guide for the removal of ventilation. This algorithm is split into three phases:

During the determination of directives and delineation of end-of-life care

Prior to discontinuation of life support or ventilator withdrawal

During and after ventilation removal

There are many tools available to help healthcare professionals deal with the difficulties of end-of-life care, but ultimately they share the common but often complicated aim of allowing patients to die with dignity. Whatever approaches are used, it is important that they are sustainable, practical and agreed upon by the healthcare team.

9.6 Conclusion

‘Dying with Dignity’ is a complex and expanding topic that is particularly relevant in neurosurgery. It is likely to become more prominent in the future as technology advances, the population ages and expectations of healthcare rise. A useful approach to the ethical problems is to follow the four principles of biomedical ethics. The role of the team is essential in both the decision-making process and in the provision of care. Formal integrated pathways can provide a pragmatic structure for care at the end of life.

Acknowledgement

The authors thank Mr. Jeremy Sharma for his invaluable help with the manuscript.

References

Beauchmap TL, Childress JF (1979) Principles of biomedical ethics. Oxford University Press, New York

Bernat JL (1997) Quality of neurological care: balancing cost control and ethics. Arch Neurol 54(11):1341–1345PubMedCrossRef

Bosshard G, Nilstun T, Bilsen J, European End-of-Life Consortium et al (2005) Forgoing treatment at the end of life in 6 European countries. Arch Intern Med 165(4):401–407PubMedCrossRef

Chan R, Webster J (2010) End-of-life care pathways for improving outcomes in caring for the dying (Review). Cochrane Database Syst Rev 1:1–16. doi:10.1002/14651858.CD008006.pub2 CrossRef

De Lora P, Blanco AP (2013) Dignifying death and the morality of elective ventilation. J Med Ethics 39(3):145–148PubMedCrossRef

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