This text-based course is a transcript of the webinar, Our Aging Patients: How to Handle End of Life Conversations, presented by Amber Heape, ClinScD, CCC-SLP, CDP
Learner Objectives
After this course, participants will be able to:
- Identify ethical considerations for therapists working with patients nearing end of life.
- List at least 3 opportunities within the scope of practice for SLPs working with patients at end of life.
- Describe how to implement cultural diversity for effective patient and family education.
Introduction and Overview
This is a quote from Pope Paul IV: "Somebody should tell us right at the start of our lives that we are dying. That we might live life to the limit, every minute of every day. Do it! I say. Whatever you want to do, do it now. There are only so many tomorrows."
I do not want this to be a sad topic because what we are going to discuss in this course focuses on how we can have a positive impact on our patients and on their families, and even at the end of life, and to make something good come out of it.
I took my daughter to see a very popular movie a couple weeks ago. She is nine. One of the lyrics from one of the songs really stood out to me. I will give you one sentence of it: "How in the midst of all this sorrow can so much hope and love endure?" That is really how I want to look at working with our aging patients and handling end-of-life conversations. Yes, in some cases, there is sorrow. But there is also hope, there is love, and there is quality of life still to be had.
End of Life Considerations and Decision-Making
Ethical Considerations for End of Life
The University of Washington Department of Bioethics says that there are four topics by which every problem in ethics should be judged. I call them “the WHs,” because they answer why, what, who, and how.
- Medical Indications- Purpose of the intervention
- Patient Preferences- What does the patient want?
- Quality of Life- How will this improve QOL?
- Contextual Features (social, economical, legal)
Medical indications tell us the purpose of the intervention. Why are we intervening? The second factor is patient preference. What does the patient want? The third factor is quality of life. The fourth is, who else is involved? Are there social, economical, or legal implications involved?
Basic Ethical Principles
There are three basic principles of ethics that I want to discuss: nonmaleficence, beneficence, and respect for autonomy. With regard to nonmaleficence, I like to think of that crazy Disney character (Maleficence) with the two horns. She is a villain, and harms people. So nonmaleficence is not harming; doing no harm. On the opposite side, beneficence is to “do good” for our patients. Then the third principle is respect for autonomy. Our patients have the right to choose. They have the right to choose whether they will comply with our recommendations. They have a right to choose, in many cases, where they will live, who will assist them, etc.
