Discussing the final moments and aftermath of life
In a bid to transform the way we relate to death, a moral philosopher and University of Cape Town medicine department instructor recently attended the annual Palliative Care Conference in Durban. The scholar, known for their work on matters relating to death, including the ethics of capital punishment and the morality of using dead bodies for medical research, ran a workshop for conference attendees on using the tools of philosophy to resolve ethical dilemmas.
The workshop, which attracted nurses, clinicians, social and community workers, and hospice carers, focused on the ethical considerations surrounding death and dying in medical education. The session emphasised the importance of compassionate, respectful, and culturally sensitive communication, which benefits both healthcare practitioners and patients by improving end-of-life care quality and emotional support.
At the heart of the discussion were four standard ethical principles: autonomy, nonmaleficence, beneficence, and justice. These principles, developed by biomedical ethicists Tom Beauchamp and James Childress in the 1970s, have dominated medical training since. The author believes that teaching these principles to medical students can help them navigate complex decisions ethically and better support those who are dying and grieving.
Respecting patient autonomy and preferences is crucial. This includes advance care planning and honoring wishes about life-sustaining treatments. In their classes, the author and their students discuss patients' rights, including the right to refuse lifesaving treatment and the right to have life-sustaining treatments withdrawn.
Balancing beneficence and non-maleficence is particularly important in contexts like pain management, symptom control, and controversial issues such as physician-assisted death. The goal is to alleviate suffering while avoiding harm.
Promoting dignity in care for the dying and the deceased is another key aspect. This emphasises respectful handling of bodies and accommodating cultural and religious practices.
Supporting patients and families through grief with sensitivity and confidentiality is vital. The author encourages fostering empathy and cultural competency in practitioners to help patients psychologically prepare for death, address death denial, and encourage meaningful reflection on life, which can facilitate acceptance and reduce fear.
For healthcare practitioners, such education can lead to enhanced ethical awareness, better communication skills, emotional resilience, and preparedness to face moral dilemmas at the end of life. For patients, it can result in more personalized, humane care that respects their values and supports their emotional and physical needs during dying.
The author, who has lost their mother to cancer and is currently facing a serious health challenge of their own, found a poignant reminder of the importance of their work in a palliative care nurse's photo of their niece with a similar condition and prognosis. The nurse, who seemed calm and at peace despite the tragic situation, embodied the compassionate, respectful, and culturally sensitive communication the author advocates for.
Incorporating death discussions in medical education fosters a more ethically grounded, patient-centered approach to end-of-life care that balances complex moral considerations with compassionate caregiving. It's a call to prepare medical students for dealing with death in their profession, starting by having conversations about death with them.
In the realm of health-and-wellness, the ethical considerations surrounding death and dying in medical education, particularly mental-health aspects, were emphasized during the workshop at the Palliative Care Conference. The discussion focused on fostering empathy and cultural competency in practitioners to support patients psychologically as they prepare for death, address death denial, and encourage reflection on life, which can facilitate acceptance and reduce fear.
