Background Transitions in end-of life care are frequent and burdensome for patients, families and professionals. This is particularly so for transitions from curative to palliative care as these pass from a treatment model to a care model. However, ethical issues, patients’ preferences, values in transitions to palliative care are seldom addressed by ethicists.
Aim To systematically review the relevant ethical issues concerning transitions from curative to palliative care.
Methods We conducted: a) comprehensive systematic literature search (2013), update cluster search (2015), b) screening of retrieved records (predefined inclusion/exclusion criteria), c) extracting and quality assessment of relevant arguments, d) assembling to ethics domains (Hofmanns’ question list on ethical issues in health technologies), e) synthesis of results.
Results Less than 50 relevant publications were identified, including a few qualitative studies and review articles. Ethical analyses were done by applying the methods of virtue ethics, casuistry and principles ethics. The publication authors identified areas complicating the transition: the nature of the process, the timing and the lack of information. Ethical issues are assigned to all these areas, including aspects (assessment/respect) of autonomy, beneficence, justice, under-/overtreatment. Patients have to abandon hope for cure and to face the impending death. Lack of time in decision-making, and inadequate information/communication on palliative care are identified risks to non-respect patients’ preferences/values.
Conclusion Although few publications on transition to palliative care exist, many relevant ethical issues were addressed by them. To contribute to a best possible end-of-life care respecting patients’ autonomy, dignity and preferences these issues should be transferred and integrated into the communications and shared decision-making on ACP.
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