Improving end of life care in older people – the ethical perspective

Professor Bobbie Farsides

Professor of Clinical and Biomedical Ethics Brighton and Sussex Medical School

In global terms it is a luxury In our own society it is something we have

grown to expect, or at least realistically hope for

People are living longer, we have added years to life, but have we added life to years?

How does our culture treat elderly people? We are tomorrow’s elderly are we prepared

for this fact? Elderly people are a ‘product’ of the context

within which they age

Vulnerable

Dependent

Non-competent

Hospitalised

In which case we need to protect them, advocate for them, manage their care.

DNAR notices

Whistle-blowing

Post –Shipman

Feisty

Independent

Demanding

Well informed

2009 Costa Book Award (formerly the Whitbread Prize) for her autobiography Somewhere Towards the End (Granta). The judges called Athill’s book “a perfect memoir of old age – candid, detailed, charming, totally lacking in self-pity or sentimentality and above all, beautifully, beautifully written.”

Family

Church, Mosque, Community groups

Nursing home staff

No one

Loss – Spouse, Friends, GP

Demystifying death and dying

Advance decisions

Proxies

Life Value Histories

Final Chapter or Important transition

Spiritual experience or biological fact

Private or public event

Welcome , unexpected, tragic, appropriate

If you believe in the sanctity of human life all lives are of value irrespective of their quality

If you do not hold this view you may believe that some lives are of such low quality they are not worth living.

Important ethical issue irrespective of age

Age specific variants e.g. ‘fair innings arguments’ QUALYs

Age neutral variants e.g. quality of life, futility, justice

Conservative management (renal dialysis)

Patient choice to refuse treatment(a) due to burdensomeness of treatment(b) as an end of life decision

Decisions made in the best interests of non-competent patients

Where do older people feature in this debate?

Where do older people feature in the evidence?

A good death recognisable as such in the context of the person’s life and dying.

Individualised Respectful Dignified Timely Acceptable