Challenges to the global issue of end of life care : training and implementing change

Abstract

End of Life (EoL) care is a field which attracts global attention and which, notwithstanding moral agreement on most issues contextually, continues globally to be a source of controversy. The reasons vary between countries from lack of clarity about law, lack of health professionals and the public on accepted moral norms, and difficulty to implement change contextually. The amount of literature and popular books published by experienced help professionals showing their frustrations in the field is testament to the medicalisation of end of life care in hospital. Whilst many religions and philosophy agree on the exception of extraordinary or futile treatment as passive euthanasia and that pain relief ought not to be considered in any way as active hastening of a terminally ill patient, comparative studies do show that in many cultures and religions this continues to be problem globally with many health professionals and patients (including their relatives) not knowing the issues well. Conversely, whilst in many countries there seems to be an increase in the number of patients who request euthanasia, as well as arguments for its legalisation based on the patients’ right to make autonomous choices, some research shows that these requests may result from an improper implementation of EoL care. Many people feel they should not die in pain unnecessarily, nor do they want to be hooked up to machines. They do not seem to realise that pain relief, even if it risks hastening death, and the refusal of treatment are recognised moral rights. [excerpt from Preface by Prof. Pierre Mallia]