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The Ethical Issues in End-of-Life Care in the Home-Based Setting

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There is a crucial question on the quality of life of patients receiving end-of-life care in the home health setting. In some instances, since patients are far removed from the hospital where they can easily have access to the latest and the most effective medical technology, they may not be receiving the best possible care in the last few months or days of their life. In a paper by Boillat, Gee, and Belavance (1997, pp. 2136-2142), they sought to assess how family physicians who are practising home care “ resolve ethical dilemmas in clinical management of homebound patients and to examine whether the self-reported, theoretical ethical positions of these physicians match their actual patient management” .

They assessed a Quebec community-based home care program with physicians covering 85 men and 65 women patients. This paper revealed that for majority of the physicians agreed with the ethical principle of patient autonomy. The study also revealed that most of the physicians agreed that patients should be placed in nursing homes even against the patient’ s wishes if the patient poses a danger to self (Boillat, Gee, and Belavance, 1997).

The paper concluded that family physicians covering home-based patients respect the ethical principles of autonomy; however, they also recognize the need to apply more practical solutions which may involve the admission of patients to nursing homes when the patient may not fit the home-based setting. In applying this paper to nursing practice, we can deduce the importance of respecting the principles of autonomy in home-based care. While the patients are in their homes, they still have the same ethical rights as if they were in the hospital or under medical facilities.

Hence, as nurses, the patient’ s autonomy should be respected and dignified. In a 2007 study by Moser, Houtepen and Widdershoven, authors set out to present a review of theoretical and empirical literature covering patient autonomy and how nurses support such autonomy. Their study was based on a premise that the concept of patient autonomy in nursing care can have various meanings. As such, nurses must resolve various ethical issues involving the application of patient autonomy. Their search covered various databases like Medline, Embase, CINAHL, and other online databases using search and the keywords patient autonomy combined with nursing.  

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