Caring for terminally ill patients is often framed by ethical issues that arise at all stages of the palliative care period and are an integral part of medical and nursing decision making. Ethical dilemmas provide no easy solution but good communication between the professional health care providers, the patients, and the families can provide the best outcome for the patient. This chapter focuses on the ethical issues encountered by primary care teams providing palliative care at home, the most primary of which is good communication. Good communication plays a vital role in determining the decisions and wishes of the patient and family and maintains a trusting relationship between the professional and the patient. The second ethical issue is informed consent, which reflects the respect for the autonomy of the patient. It means respect for the decision of the patient before administering medical interventions. Another issue prevalent in palliative care is confidentiality, wherein professionals are expected not to divulge information without the explicit consent of the patient. Compassion, which is often ignored by professionals, should be encouraged, as it reflects the emotional aspects of caring and may help to foster a trusting relationship between patients and professionals. Advanced directives and living wills also form part of the ethical issues. General practitioners are often in the best position to discuss wills with the patients and their families. The last, yet most ethically arresting issue, is the withdrawal of feeding and fluids and euthanasia. Both should be reviewed and undertaken within the views of the family and the patient.
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