Ethics and End-of-Life Decision Making

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When faced with difficult, complex, and multiple choices for health care treatment, patients and families draw on their inner resources, which may include cultural expectations of treatment, familial supports, and spiritual or religious beliefs. Along with these strengths patients and families may be faced with barriers to health care or treatment which may include lack of access as a result of language, education, and economic limitations or decreased formal and informal support systems. Provider and patient differences in culture, values, spiritual/religious, health beliefs, and worldviews, can add to the complexity of end of life or health care decision making by Hispanic/Latino elders. The following is a universal model to follow when addressing medical ethical issues:

The Four Umpires: A Paradigm for Ethical Leadership
(Caldwell and Bischoff 2002)
  • 1. Medical Indications
  • 2. Quality of Life
  • 3. Patient Preferences
  • 4. Contextual Features