Ethical dilemmas in palliative care: a study in Taiwan
Objectives—To investigate the incidence and solution of ethical dilemmas in a palliative care unit. Design—Health care workers recorded daily all dilemmas in caring for each patient. Setting—Palliative care unit of National Taiwan University Hospital in Taiwan. Patients—Two hundred and forty-six con...
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| Veröffentlicht in: | Journal of medical ethics 2000-10, Vol.26 (5), p.353-357 |
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| creator | Chiu, Tai-Yuan Hu, Wen-Yu Cheng, Shao-Yi Chen, Ching-Yu |
| description | Objectives—To investigate the incidence and solution of ethical dilemmas in a palliative care unit. Design—Health care workers recorded daily all dilemmas in caring for each patient. Setting—Palliative care unit of National Taiwan University Hospital in Taiwan. Patients—Two hundred and forty-six consecutive patients with terminal cancer during 1997-8. Main measurement—Ethical dilemmas in the questionnaire were categorised as follows: telling the truth; place of care; therapeutic strategy; hydration and nutrition; blood transfusion; alternative treatment; terminal sedation; use of medication, and others. Results—The type and frequency of ethical dilemmas encountered were: place of care (33.3%); truth-telling (32.1%); hydration and nutrition (25.2%); therapeutic strategy (24.8%), and use of medication (19.1%). Ethical problems relating to the place of care and to therapeutic strategy were unlikely to be solved with increased hospital stay and some ethical dilemmas remained unsolved even in the final week in hospital, including place of care (23.2%), truth-telling (17.1%) and therapeutic strategy (11.4%). Problems of truth-telling occurred in nearly half (42.6%) of patients over sixty-five-years-old. Conflicts about blood transfusion were experienced in all patients below 18-years-old, and the dilemmas concerning the place of care occurred most frequently with head and neck cancer patients (43.8%). Conclusions—The solution of ethical dilemmas required refocusing by medical professionals on the importance of continuing communication. Improved ethical training for professionals would contribute to solving the moral dilemmas of palliative care. |
| doi_str_mv | 10.1136/jme.26.5.353 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_1733275</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A66810535</galeid><jstor_id>27718566</jstor_id><sourcerecordid>A66810535</sourcerecordid><originalsourceid>FETCH-LOGICAL-b739t-f96f644f8a439440d0896469c83961e1c2145353a3eb43c609a5b5e2d569759c3</originalsourceid><addsrcrecordid>eNqFks9v0zAcxS0EYl3hxhUUCWlwWIod_-aANFVjICompLEDF8t1vulcnKTEyWD_Pa5adRRVYB98eB89Pb_vF6FnBE8IoeLNsoZJISZ8Qjl9gEaESZqzgsuHaIQpFrlQGB-h4xiXOJ1C6cfoiBDMOaZqhMR5f-OdDVnpA9S1jZlvspUNwdve30LmbAdvM5vFfijv1tqV9T9t8wQ9qmyI8HT7jtHX9-dX0w_57PLi4_Rsls8l1X1eaVEJxiplGdWM4RIrLZjQTlEtCBBXEMZTbkthzqgTWFs-51CUXGjJtaNj9G7juxrmNZQOmr6zwaw6X9vuzrTWm32l8Tdm0d4aIiktJE8GJ1uDrv0xQOxN7aODEGwD7RCNLKgkVK_Bl3-By3bomvS55KVS0_i_FMdKCZZ6HaPTDbWwAYxvqjZlcwtoIEVsG6hS1-ZMCJXGQNem-QE83RJq7w7xr_f4hPTwq1_YIUajLmZ76Okh1LUhwAJMmtX08hDuujbGDqpd0wSb9baZtG2mEIabRCf8xZ_TuYe365WA5xtgGfu22-mFlERxIe5_7mOKtdNt990ISSU3n6-nRqtPX8g1-2bW-V5t-Hm9_He036kC75A</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1781130395</pqid></control><display><type>article</type><title>Ethical dilemmas in palliative care: a study in Taiwan</title><source>Jstor Complete Legacy</source><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><source>Periodicals Index Online</source><creator>Chiu, Tai-Yuan ; Hu, Wen-Yu ; Cheng, Shao-Yi ; Chen, Ching-Yu</creator><creatorcontrib>Chiu, Tai-Yuan ; Hu, Wen-Yu ; Cheng, Shao-Yi ; Chen, Ching-Yu</creatorcontrib><description>Objectives—To investigate the incidence and solution of ethical dilemmas in a palliative care unit. Design—Health care workers recorded daily all dilemmas in caring for each patient. Setting—Palliative care unit of National Taiwan University Hospital in Taiwan. Patients—Two hundred and forty-six consecutive patients with terminal cancer during 1997-8. Main measurement—Ethical dilemmas in the questionnaire were categorised as follows: telling the truth; place of care; therapeutic strategy; hydration and nutrition; blood transfusion; alternative treatment; terminal sedation; use of medication, and others. Results—The type and frequency of ethical dilemmas encountered were: place of care (33.3%); truth-telling (32.1%); hydration and nutrition (25.2%); therapeutic strategy (24.8%), and use of medication (19.1%). Ethical problems relating to the place of care and to therapeutic strategy were unlikely to be solved with increased hospital stay and some ethical dilemmas remained unsolved even in the final week in hospital, including place of care (23.2%), truth-telling (17.1%) and therapeutic strategy (11.4%). Problems of truth-telling occurred in nearly half (42.6%) of patients over sixty-five-years-old. Conflicts about blood transfusion were experienced in all patients below 18-years-old, and the dilemmas concerning the place of care occurred most frequently with head and neck cancer patients (43.8%). Conclusions—The solution of ethical dilemmas required refocusing by medical professionals on the importance of continuing communication. Improved ethical training for professionals would contribute to solving the moral dilemmas of palliative care.</description><identifier>ISSN: 0306-6800</identifier><identifier>EISSN: 1473-4257</identifier><identifier>DOI: 10.1136/jme.26.5.353</identifier><identifier>PMID: 11055038</identifier><identifier>CODEN: JMETDR</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd and Institute of Medical Ethics</publisher><subject>Aged ; Bioethics ; Blood transfusion ; Cancer ; Data Interpretation, Statistical ; Decision making ; ethical dilemma ; Ethical dilemmas ; Ethics, Medical ; Female ; Health care policy ; Hospice care ; Hospice Care - standards ; Hospice Care - statistics & numerical data ; Hospital Units - standards ; Hospitalization ; Hospitals ; Hospitals, University - standards ; Humans ; Hydration ; Length of stay ; Male ; Medical ethics ; Medical treatment ; Medications ; Middle Aged ; Nutrition ; Pain ; Palliative care ; Palliative Care - standards ; Palliative Care - statistics & numerical data ; Parenteral nutrition ; Patient Discharge - standards ; Patient Participation ; Quality of life ; Questionnaires ; Statistical analysis ; Surveys and Questionnaires ; Taiwan ; terminal care ; University hospitals</subject><ispartof>Journal of medical ethics, 2000-10, Vol.26 (5), p.353-357</ispartof><rights>Copyright 2000 by the Journal of Medical Ethics</rights><rights>Copyright 2000 Journal of Medical Ethics</rights><rights>COPYRIGHT 2000 BMJ Publishing Group Ltd.</rights><rights>COPYRIGHT 2000 BMJ Publishing Group Ltd.</rights><rights>Copyright: 2000 Copyright 2000 by the Journal of Medical Ethics</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b739t-f96f644f8a439440d0896469c83961e1c2145353a3eb43c609a5b5e2d569759c3</citedby><cites>FETCH-LOGICAL-b739t-f96f644f8a439440d0896469c83961e1c2145353a3eb43c609a5b5e2d569759c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/27718566$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/27718566$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>230,314,723,776,780,799,881,27846,27901,27902,53766,53768,57992,58225</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11055038$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chiu, Tai-Yuan</creatorcontrib><creatorcontrib>Hu, Wen-Yu</creatorcontrib><creatorcontrib>Cheng, Shao-Yi</creatorcontrib><creatorcontrib>Chen, Ching-Yu</creatorcontrib><title>Ethical dilemmas in palliative care: a study in Taiwan</title><title>Journal of medical ethics</title><addtitle>J Med Ethics</addtitle><description>Objectives—To investigate the incidence and solution of ethical dilemmas in a palliative care unit. Design—Health care workers recorded daily all dilemmas in caring for each patient. Setting—Palliative care unit of National Taiwan University Hospital in Taiwan. Patients—Two hundred and forty-six consecutive patients with terminal cancer during 1997-8. Main measurement—Ethical dilemmas in the questionnaire were categorised as follows: telling the truth; place of care; therapeutic strategy; hydration and nutrition; blood transfusion; alternative treatment; terminal sedation; use of medication, and others. Results—The type and frequency of ethical dilemmas encountered were: place of care (33.3%); truth-telling (32.1%); hydration and nutrition (25.2%); therapeutic strategy (24.8%), and use of medication (19.1%). Ethical problems relating to the place of care and to therapeutic strategy were unlikely to be solved with increased hospital stay and some ethical dilemmas remained unsolved even in the final week in hospital, including place of care (23.2%), truth-telling (17.1%) and therapeutic strategy (11.4%). Problems of truth-telling occurred in nearly half (42.6%) of patients over sixty-five-years-old. Conflicts about blood transfusion were experienced in all patients below 18-years-old, and the dilemmas concerning the place of care occurred most frequently with head and neck cancer patients (43.8%). Conclusions—The solution of ethical dilemmas required refocusing by medical professionals on the importance of continuing communication. Improved ethical training for professionals would contribute to solving the moral dilemmas of palliative care.</description><subject>Aged</subject><subject>Bioethics</subject><subject>Blood transfusion</subject><subject>Cancer</subject><subject>Data Interpretation, Statistical</subject><subject>Decision making</subject><subject>ethical dilemma</subject><subject>Ethical dilemmas</subject><subject>Ethics, Medical</subject><subject>Female</subject><subject>Health care policy</subject><subject>Hospice care</subject><subject>Hospice Care - standards</subject><subject>Hospice Care - statistics & numerical data</subject><subject>Hospital Units - standards</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Hospitals, University - standards</subject><subject>Humans</subject><subject>Hydration</subject><subject>Length of stay</subject><subject>Male</subject><subject>Medical ethics</subject><subject>Medical treatment</subject><subject>Medications</subject><subject>Middle Aged</subject><subject>Nutrition</subject><subject>Pain</subject><subject>Palliative care</subject><subject>Palliative Care - standards</subject><subject>Palliative Care - statistics & numerical data</subject><subject>Parenteral nutrition</subject><subject>Patient Discharge - standards</subject><subject>Patient Participation</subject><subject>Quality of life</subject><subject>Questionnaires</subject><subject>Statistical analysis</subject><subject>Surveys and Questionnaires</subject><subject>Taiwan</subject><subject>terminal care</subject><subject>University hospitals</subject><issn>0306-6800</issn><issn>1473-4257</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>K30</sourceid><sourceid>8G5</sourceid><sourceid>AVQMV</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>K50</sourceid><sourceid>M1D</sourceid><sourceid>M2O</sourceid><recordid>eNqFks9v0zAcxS0EYl3hxhUUCWlwWIod_-aANFVjICompLEDF8t1vulcnKTEyWD_Pa5adRRVYB98eB89Pb_vF6FnBE8IoeLNsoZJISZ8Qjl9gEaESZqzgsuHaIQpFrlQGB-h4xiXOJ1C6cfoiBDMOaZqhMR5f-OdDVnpA9S1jZlvspUNwdve30LmbAdvM5vFfijv1tqV9T9t8wQ9qmyI8HT7jtHX9-dX0w_57PLi4_Rsls8l1X1eaVEJxiplGdWM4RIrLZjQTlEtCBBXEMZTbkthzqgTWFs-51CUXGjJtaNj9G7juxrmNZQOmr6zwaw6X9vuzrTWm32l8Tdm0d4aIiktJE8GJ1uDrv0xQOxN7aODEGwD7RCNLKgkVK_Bl3-By3bomvS55KVS0_i_FMdKCZZ6HaPTDbWwAYxvqjZlcwtoIEVsG6hS1-ZMCJXGQNem-QE83RJq7w7xr_f4hPTwq1_YIUajLmZ76Okh1LUhwAJMmtX08hDuujbGDqpd0wSb9baZtG2mEIabRCf8xZ_TuYe365WA5xtgGfu22-mFlERxIe5_7mOKtdNt990ISSU3n6-nRqtPX8g1-2bW-V5t-Hm9_He036kC75A</recordid><startdate>20001001</startdate><enddate>20001001</enddate><creator>Chiu, Tai-Yuan</creator><creator>Hu, Wen-Yu</creator><creator>Cheng, Shao-Yi</creator><creator>Chen, Ching-Yu</creator><general>BMJ Publishing Group Ltd and Institute of Medical Ethics</general><general>BMJ Publishing Group</general><general>BMJ Publishing Group Ltd</general><general>Society for the Study of Medical Ethics</general><general>BMJ Publishing Group LTD</general><general>BMJ Group</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>8GL</scope><scope>HFIND</scope><scope>IOIBA</scope><scope>K30</scope><scope>PAAUG</scope><scope>PAWHS</scope><scope>PAWZZ</scope><scope>PAXOH</scope><scope>PBHAV</scope><scope>PBQSW</scope><scope>PBYQZ</scope><scope>PCIWU</scope><scope>PCMID</scope><scope>PCZJX</scope><scope>PDGRG</scope><scope>PDWWI</scope><scope>PETMR</scope><scope>PFVGT</scope><scope>PGXDX</scope><scope>PIHIL</scope><scope>PISVA</scope><scope>PJCTQ</scope><scope>PJTMS</scope><scope>PLCHJ</scope><scope>PMHAD</scope><scope>PNQDJ</scope><scope>POUND</scope><scope>PPLAD</scope><scope>PQAPC</scope><scope>PQCAN</scope><scope>PQCMW</scope><scope>PQEME</scope><scope>PQHKH</scope><scope>PQMID</scope><scope>PQNCT</scope><scope>PQNET</scope><scope>PQSCT</scope><scope>PQSET</scope><scope>PSVJG</scope><scope>PVMQY</scope><scope>PZGFC</scope><scope>0-V</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>88J</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>AABKS</scope><scope>ABSDQ</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>AVQMV</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K50</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1D</scope><scope>M1P</scope><scope>M2O</scope><scope>M2P</scope><scope>M2R</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20001001</creationdate><title>Ethical dilemmas in palliative care: a study in Taiwan</title><author>Chiu, Tai-Yuan ; Hu, Wen-Yu ; Cheng, Shao-Yi ; Chen, Ching-Yu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b739t-f96f644f8a439440d0896469c83961e1c2145353a3eb43c609a5b5e2d569759c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Aged</topic><topic>Bioethics</topic><topic>Blood transfusion</topic><topic>Cancer</topic><topic>Data Interpretation, Statistical</topic><topic>Decision making</topic><topic>ethical dilemma</topic><topic>Ethical dilemmas</topic><topic>Ethics, Medical</topic><topic>Female</topic><topic>Health care policy</topic><topic>Hospice care</topic><topic>Hospice Care - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of medical ethics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chiu, Tai-Yuan</au><au>Hu, Wen-Yu</au><au>Cheng, Shao-Yi</au><au>Chen, Ching-Yu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ethical dilemmas in palliative care: a study in Taiwan</atitle><jtitle>Journal of medical ethics</jtitle><addtitle>J Med Ethics</addtitle><date>2000-10-01</date><risdate>2000</risdate><volume>26</volume><issue>5</issue><spage>353</spage><epage>357</epage><pages>353-357</pages><issn>0306-6800</issn><eissn>1473-4257</eissn><coden>JMETDR</coden><abstract>Objectives—To investigate the incidence and solution of ethical dilemmas in a palliative care unit. Design—Health care workers recorded daily all dilemmas in caring for each patient. Setting—Palliative care unit of National Taiwan University Hospital in Taiwan. Patients—Two hundred and forty-six consecutive patients with terminal cancer during 1997-8. Main measurement—Ethical dilemmas in the questionnaire were categorised as follows: telling the truth; place of care; therapeutic strategy; hydration and nutrition; blood transfusion; alternative treatment; terminal sedation; use of medication, and others. Results—The type and frequency of ethical dilemmas encountered were: place of care (33.3%); truth-telling (32.1%); hydration and nutrition (25.2%); therapeutic strategy (24.8%), and use of medication (19.1%). Ethical problems relating to the place of care and to therapeutic strategy were unlikely to be solved with increased hospital stay and some ethical dilemmas remained unsolved even in the final week in hospital, including place of care (23.2%), truth-telling (17.1%) and therapeutic strategy (11.4%). Problems of truth-telling occurred in nearly half (42.6%) of patients over sixty-five-years-old. Conflicts about blood transfusion were experienced in all patients below 18-years-old, and the dilemmas concerning the place of care occurred most frequently with head and neck cancer patients (43.8%). Conclusions—The solution of ethical dilemmas required refocusing by medical professionals on the importance of continuing communication. Improved ethical training for professionals would contribute to solving the moral dilemmas of palliative care.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd and Institute of Medical Ethics</pub><pmid>11055038</pmid><doi>10.1136/jme.26.5.353</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0306-6800 |
| ispartof | Journal of medical ethics, 2000-10, Vol.26 (5), p.353-357 |
| issn | 0306-6800 1473-4257 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_1733275 |
| source | Jstor Complete Legacy; MEDLINE; EZB-FREE-00999 freely available EZB journals; PubMed Central; Alma/SFX Local Collection; Periodicals Index Online |
| subjects | Aged Bioethics Blood transfusion Cancer Data Interpretation, Statistical Decision making ethical dilemma Ethical dilemmas Ethics, Medical Female Health care policy Hospice care Hospice Care - standards Hospice Care - statistics & numerical data Hospital Units - standards Hospitalization Hospitals Hospitals, University - standards Humans Hydration Length of stay Male Medical ethics Medical treatment Medications Middle Aged Nutrition Pain Palliative care Palliative Care - standards Palliative Care - statistics & numerical data Parenteral nutrition Patient Discharge - standards Patient Participation Quality of life Questionnaires Statistical analysis Surveys and Questionnaires Taiwan terminal care University hospitals |
| title | Ethical dilemmas in palliative care: a study in Taiwan |
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