Tuesday, March 3, 2009

Ethics and Palliative Volunteers

An article in the 2009 issue of American Journal of Hospice and Palliative Medicine I found interesting was concerning hospice volunteers who get very little training before going onto the ward. This was a US study, but the same thing applies at least here in Vancouver.

The four ethical challenges outlined in the paper from Canadian palliative volunteers are the easy ones to answer, at least for a volunteer since in that position you defer responsibility of medically related enquiries to the medical staff. That takes care of challenges 1 and 3 (communication with anyone other than patient regarding their status), and 4 (personal medical concerns about the patient). Challenge 2 (being asked for opinions by the patient) is also pretty straightforward; don’t if you don’t want to. If a patient asks which funeral home you think they should go with, list a few different places and let them decide that way. Or ask them what they were thinking of going with and how they came to that decision. Or say that you don’t really know much about the topic and refer them to the nurses or family.

The article also talks about accepting gifts and listening to suicide talk/requests, which are more complicated issues, but still manageable.

In the introduction, more interesting examples were given which I will answer with extreme brevity here:

“…whether to address honestly the patient’s questions about whether she was dying while also respecting the family’s wishes that she not be told…” Defer to doctor – “I’m afraid I’m not given any medical information. You should ask your doctor next time you see him.”

“…whether to help a patient go to his garage (at some physical risk and with great difficulty) to destroy materials he did not want his wife to see…” You should never put yourself, or the patient, at risk.

“…whether to write a letter from the patient to someone the caregiver would not approve of…” Yes.

“…whether to speak up when the volunteer believed that the patient was seriously overmedicated…” Of course you should speak up, just remember that staff might not listen to you.

“…how to address issues of morality raised by the patient herself regarding a longheld
secret about a pregnancy before her marriage.” This would be much like any therapy situation; ask questions (don’t give opinions if uncomfortable), don’t judge, and listen attentively.

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