C C E E N N L L E E End-of-Life Nursing Education Consortium International Curriculum Ethical Issues and Cultural Considerations in Palliative Care

E E N N E E C C L L International Curriculum Responding to Ethical Issues in Palliative Care Ethical dilemmas on macro and micro levels emerge daily in palliative care Prince-Paul & Daly, 2010 Ethical dilemmas on macro and micro levels emerge daily in palliative care Prince-Paul & Daly,

E E N N E E C C L L International Curriculum Responding to Ethical Issues in Palliative Care Changes in social/family systems have added to complexity of end-of- life/palliative care Palliative care staff help patients make fully informed decisions Changes in social/family systems have added to complexity of end-of- life/palliative care Palliative care staff help patients make fully informed decisions 3

E E N N E E C C L L International Curriculum Ethics Competencies Palliative care staff play a critical role in legal/ethical issues Acquisition of knowledge, skill and core competencies Identification, evaluation, resolution of ethical issues Palliative care staff play a critical role in legal/ethical issues Acquisition of knowledge, skill and core competencies Identification, evaluation, resolution of ethical issues 4

E E N N E E C C L L International Curriculum Ethical Principles (From a Western Perspective) Autonomy Beneficence Nonmaleficence Justice Autonomy Beneficence Nonmaleficence Justice 5

E E N N E E C C L L International Curriculum Issues of Communication and Shared Decision Making Disclosure Confidentiality Disclosure Confidentiality 6

E E N N E E C C L L International Curriculum Issues of Communication and Shared Decision Making (from a Western Perspective) Informed Consent Decisional Capacity Informed Consent Decisional Capacity 7

E E N N E E C C L L International Curriculum Issues of Communication and Shared Decision Making (cont.) Decision making capacity for marginalized groups –Patients with dementia/mental illness –Patients with developmental disabilities –Prisoners Decision making capacity for marginalized groups –Patients with dementia/mental illness –Patients with developmental disabilities –Prisoners 8

E E N N E E C C L L International Curriculum Preventive Ethics Health professionals should focus efforts on preventing the occurrence of conflicts Early identification of issues Knowledge of the natural history of many illnesses Hameric & Delgado, 2005 Health professionals should focus efforts on preventing the occurrence of conflicts Early identification of issues Knowledge of the natural history of many illnesses Hameric & Delgado,

E E N N E E C C L L International Curriculum Preventative Ethics (cont.) Understanding of patient/family wishes Cultural and spiritual assessment Communication skills Understanding of patient/family wishes Cultural and spiritual assessment Communication skills 10

E E N N E E C C L L International Curriculum Answering the Unanswerable Questions 11

E E N N E E C C L L International Curriculum Facilitating Ethical and Legal Practice The 4 Box Method Quality of Life Patient Preferences Clinical Indications Contextual Features Jonsen et al.,

E E N N E E C C L L International Curriculum Clinical Indications Indications for and against the intervention Reflects the goals of care What are common ethical dilemmas in your culture? Indications for and against the intervention Reflects the goals of care What are common ethical dilemmas in your culture? 13

E E N N E E C C L L International Curriculum Patient Preferences Cultural, ethnic and age related differences must be taken into consideration. 14

E E N N E E C C L L International Curriculum Quality of Life Evaluation of prior quality of life Expected quality of life with and without treatment Evaluation of prior quality of life Expected quality of life with and without treatment 15

E E N N E E C C L L International Curriculum Contextual Features Social, legal, economic and institutional circumstances Context features must be determined and assessed Social, legal, economic and institutional circumstances Context features must be determined and assessed 16

E E N N E E C C L L International Curriculum Conclusion Address values and understanding of needs Advocate for patient/family rights Work closely with other disciplines Address values and understanding of needs Advocate for patient/family rights Work closely with other disciplines 17

E E N N E E C C L L International Curriculum Collaboration 18

E E N N E E C C L L International Curriculum Culture Defined A system of shared symbols Provides security, integrity, belonging Constantly evolving A system of shared symbols Provides security, integrity, belonging Constantly evolving 19

E E N N E E C C L L International Curriculum Cultural Context Making meaning of illness Not limited to race or ethnicity Health disparities Making meaning of illness Not limited to race or ethnicity Health disparities 20

E E N N E E C C L L International Curriculum Cultural Competence Components Importance of interdisciplinary approach Components Importance of interdisciplinary approach 21

E E N N E E C C L L International Curriculum Cultural Assessment Cultural attributes Variation within groups Cultural attributes Variation within groups 22

E E N N E E C C L L International Curriculum A Mother's Touch 23

E E N N E E C C L L International Curriculum Components within Culture Ethnicity Race Gender Age Religion and spirituality Sexual orientation Ethnicity Race Gender Age Religion and spirituality Sexual orientation 24

E E N N E E C C L L International Curriculum Fathers Watch 25

E E N N E E C C L L International Curriculum Differing abilities Financial status Employment Education level Cause of death Differing abilities Financial status Employment Education level Cause of death Components within Culture (cont.) 26

E E N N E E C C L L International Curriculum Components of Cultural Assessment Patient/family/community –Birthplace –Ethnic identity, community –Decision making –Language and communication Patient/family/community –Birthplace –Ethnic identity, community –Decision making –Language and communication 27

E E N N E E C C L L International Curriculum Components of Cultural Assessment (cont.) Religion Food preferences/prohibitions Economic situation Health beliefs regarding death, grief, pain, traditional therapies, care of the body Religion Food preferences/prohibitions Economic situation Health beliefs regarding death, grief, pain, traditional therapies, care of the body 28

E E N N E E C C L L International Curriculum Self Assessment of Culture Self assessment Cultural beliefs of co-workers Self assessment Cultural beliefs of co-workers 29

E E N N E E C C L L International Curriculum Reaching Out 30

E E N N E E C C L L International Curriculum Cultural Considerations of Communication Use of interpreters Conversation style Personal space Eye contact Use of interpreters Conversation style Personal space Eye contact 31

E E N N E E C C L L International Curriculum Cultural Considerations of Communication (cont.) Touch Time orientation View of healthcare professionals Learning styles Touch Time orientation View of healthcare professionals Learning styles 32

E E N N E E C C L L International Curriculum Role of the Family Who makes decisions? Who is included in discussions? Is full disclosure acceptable? Who makes decisions? Who is included in discussions? Is full disclosure acceptable? 33

E E N N E E C C L L International Curriculum Cultural Influences on Decision Making Beliefs about autonomy and other values differ Disclosure of diagnosis and prognosis Ascertain desire for disclosure 34

E E N N E E C C L L International Curriculum Language Used at the End of Life "Discontinuation" "DNR" "Withdrawing/withholding" "Discontinuation" "DNR" "Withdrawing/withholding" 35

E E N N E E C C L L International Curriculum When Cultures Clash Clashes occur Assess your reactions Never lie Offer information Use interpreters Clashes occur Assess your reactions Never lie Offer information Use interpreters 36

E E N N E E C C L L International Curriculum Conclusion Culture is a major influence on end-of-life care Self-assessment of culture Many dimensions of culture Culturally sensitive care Interdisciplinary care Culture is a major influence on end-of-life care Self-assessment of culture Many dimensions of culture Culturally sensitive care Interdisciplinary care 37

E E N N E E C C L L International Curriculum Caring for the Body and Soul 38

E E N N E E C C L L International Curriculum Give the answers to the following questions please 1.What are the Ethical Principles (From a Western Perspective)? 2.List the Components within Culture. 3.Describe Cultural Considerations of Communication 1.What are the Ethical Principles (From a Western Perspective)? 2.List the Components within Culture. 3.Describe Cultural Considerations of Communication