End Of Life Care Ethics

Maria Kabushinskaya

Health care ethics is at its most basic definition is a set of moral principles, beliefs and values that guide the Physician Assistant in making choices about medical care for their patients. The central belief of health care ethics is the sense of right and wrong and the principles about what rights we possess, along with the duties as Physician Assistants we owe our patients. (Opacic, D. A. 2003) One must consider carefully all aspects of health care decisions as it helps us make choices that are just.

End of Life

At times, ethical questions do arise when the correct path is not present or when there is a disagreement between the medical professional and the patient. Common ethical questions could arise which include

questions as when one should consider end of life for their patient or should life substantiating technology such as feeding tubes or breathing machines be started continued or stopped. The ethical question comes into play of who is in charge of making this decision for the patient when they are unable to answer for themselves? Does the Doctor or Physician Assistant have the authority to make decisions or does this defer to the family when the patient is unable to answer for themselves. All these questions lead the medical professional to pull from their experiences of right and wrong, and deferring to written law of ethics to insure a correct decision is made. (Medical Ethics. (n.d.))
The Physician Assistant program we will compare is currently under development in England since 2002 and is still considered an evolving profession.

The program came into existence after a study of the role of the American Physician Assistant program and the need for a workforce that is suitable for the future.

England has a set of standards that are published in the General Medical Council Standards and Ethic’s guide. (End of life care: Contents. n.d.) Compared to the United States, England’s guide to End of Life compares to United States standards as it lays out the principles for treating the patients with dignity, respect and compassion when facing difficult decisions about care. This also states that the patients privacy and confidentially must be honored. This is a basic human rights act that transcends both cultures as covered by the Human Rights Act of 1998.

Another similarity to both code of ethics focuses on palliative care and how this is presented to the patient and their family. This care will include how pain is managed or other symptoms that will put additional stress on the patient. It is also important to consider the family to including psychological, social and spiritual support.

Physician Assistants as Expert

Witnesses
The GMC and Untied States code of ethics has set aside a guideline for doctors acting as legal witness in proceedings.

The GMC states, as with the United States, outlines that one must be familiar with the guidelines and developments that are involved in the work that you are performing. It is important to keep up to date and follow the legal aspects that the doctor or Physician Assistant can operate within depending on the state or country that the medical professional resides in. That is keeping within the confines of the law that the state outlines the contract that the medical professional is governed under.

It is also morally correct to realize that one must work within the limits of their knowledge, the Physician Assistant or doctor must not over step their boundaries, this could hold one liable for the outcomes, especially when they do not have professional knowledge of the subject being addressed.

In both cultures honesty and trustworthiness is important when giving expert witness accounts especially when under oath in courts or tribunals. It is important that one not make false or misleading statements. It is important to take reasonable steps to insure that the information being presented is correct and pertinent information is not intentionally left out. (Annals of Family Medicine.

n.d.).
When performing as an expert witness they should recognize that there is uncertainty within the medical practice. The medical field is an ever changing and dynamic science that is based upon concepts of probability and science instead of unqualified certainty. In providing expert testimony the Physician Assistant needs to have in mind the distinction between the occurrences of an unavoidable complications in medical practices that do not represent malpractice. Those actions that unfortunately result in a bad outcome but represent good medical care and those that have incidents because of negligence of a company or individual. (Scott, R. A. 1999)
In conclusion there are many similarities in the code of ethic between the United States and England within the medical field. It is important to note that unlike the Physician Assistants in the United States, this role in the United Kingdom is still growing and defining itself. As of the beginning of 2009 there are over 150 PA students in training in the United Kingdom and approximately 20 United Kingdom graduates currently in clinical practice.
Their challenges to develop both professionally and advance a solid moral code of ethics will continue as priorities to include regulation and professional development, these will take precedence during the development lifecycle. Though, the impact of this role on the United Kingdom health care will continue to be vast and there improvements that this will represent to the patient will be a positive experience.