1. Ethics of End of Life Care Chan Tuck Wai B.Sc. (Pharmacy), MBA Certified IRB Professional (USA) Human Protection Administrator National University Hospital, National University of Singapore

2. What do I want during my last 6 months?  A Healthy Birth  A Happy Life  A Good Death

3. 12 Principles of Good Death  Understand Death  Retain Control  Dignity and Privacy  Control Pain  Place of Death  Access to Info, Experts  Spiritual Support  Hospice Care  Who will share my end  Advance Directives  Time to say Goodbye  No prolongation of suffering

4. The Truth There is a major mismatch between people’s preferences for where they should die and their actual place of death Most would probably like to die at home Only around 18% do so with a further 17% in care homes Acute hospitals accounting for 58% of all deaths Around 4% in hospices Only around one third of general public have discussed death and dying with anyone

5. What is EOL care?  Key domain of Care  Physical  Psychological  Social  Spiritual  Key aspect of Care Symptoms Control Comfort measures Anticipatory prescribing of medication Discontinuation of inappropriate interventions Psychological and spiritual care Care of the family

6. Sufferings of EOL  Pain  Sleep  Breathing  Metabolic  Digestive  Skin  Emotional

7. Kubler-Ross model on EOL patients  Denial – “I feel fine, This can’t be happening, not to me.”  Anger – “Why me? It’s not fair! Who is to blame?”  Bargaining – “Just let me live to see my children graduate”  Depression – “Why bother with anything? What’s the point?”  Acceptance – “I am going to ok, I Can’t fight it, I may as well prepare for it.”

8. Improve Quality of Life  Symptomatic relief  Adding life to days and not days to life  First DO not Harm  Treatment should not be a burden  QOL improves despite not finding CURE  End point is Death

9. Ethics Consideration  Respect  Beneficence  Non-Maleficence  Justice

10. Respect is most Important  Respect for patients  Respect for family  Voluntary Informed Consent  Every treatment must be explained and accepted by the patient and family  Role of family in patient care

11. Communication is crucial  Communicate regularly with patients and care givers  Communicate with previously consulted practitioners to obtain patient’s medical history and emotional state of mind  Must learn to LET GO

12. Thank You Questions and Answers