The goal of palliative care is to maintain the quality of life while neither hastening nor postponing death
☛ death is the natural end of life
☛ there is no ethic, in any culture or religion, which say that a terminally ill patient must be kept alive by any means
☛ what matters is the quality of life left to the patient, not the time which is left to them
☛ palliative care must never become an exercise in prolonging life
Whether it is appropriate to offer or to withhold or withdraw a particular therapy depends on the balance between the possible benefits and the potential risks of the treatment, i.e. what is in the patient’s best interests
☛ it will depend on individual clinical circumstances
☛ it is often difficult and complex
☛ futile therapy, with no chance of benefit (“You have to do something!”), can never be justified
Example 1 Should a terminally patient receive antibiotics for chest
infection?
☛ depends on many factors, including
o the patient’s nearness to death
o the wishes of the patient and their family
o the expected benefits from the patient’s point of view
☛ if the antibiotics
o will merely prolong the dying process, they are probably best withheld
o will control distressing symptoms unresponsive to other measures, such as pyrexia or delirium, they may be of benefit
Example 2 How should renal failure caused by ureteric obstruction due to advanced cancer be managed?
☛ if the patient was terminally ill because of cancer before renal failure supervened, active therapy is probably inappropriate
☛ if the patient was previously relatively well and has a reasonable life expectancy except for the effects of renal failure, consideration for stenting or nephrostomy insertion is appropriate
Source:
The IAHPC Manual of Palliative Care 3rd Edition
https://web.archive.org/web/20210122105526/https://hospicecare.com/uploads/2013/9/The%20IAHPC%20Manual%20of%20Palliative%20Care%203e.pdf
