A multitude of challenges are likely to confront the field of palliative care in the coming years, many of these with huge ethical implications. With demographic shifts resulting in the over-65 population resting at almost 12 million, combined with an unprecedented increase in the burden of diseases of old age such as dementia; it is likely that palliative care as a specialty will need to adapt to new demands. These challenges are compounded by considerable uncertainties surrounding funding, which will undoubtedly lead to difficult resource allocation decisions. Furthermore, ease of access to palliative care services varies considerably across society, with individuals with mental health conditions, a non-cancer diagnosis or belonging to BAME or LGBT communities all facing substantial barriers to access. This essay aims to examine how the fundamental principles of medical ethics such as beneficence, non-maleficence, justice and autonomy can be applied to the aforementioned challenges.
No proposals in isolation are likely to address all of the above challenges. Improved integration between general practice and palliative care services could significantly improve access to care however this will require further investment in an already overstretched primary care service. Extending opportunities to learn about palliative care to other health care professionals may also help to improve their confidence in treating this population. With projections indicating that care homes are likely to become the ‘hospices of the future’ it is vital that individuals working in these areas are adequately trained and able to work within a well-supported multi-disciplinary team. Disparities in access between societal groups will also need to be further studied in order for these to be levelled. Crucially addressing the above challenges must be done in a way that retains the holistic and individualistic nature, that is so integral to the speciality.
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