Ethical issues at the end of life

The combination of increased life span and medical interventions has created sometimes a protracted dying process, which is the source of many ethical concerns at the end of life. Basic ethical principles, ie, autonomy, nonmaleficence, beneficence, justice, and double effect, are the cornerstones of decisions made at the end of life. Examples of items being discussed are: informed consent, advanced directives, surrogate, DNR, hospice and palliative care. New concepts such as “limit settings” on interventions at the end of life or “futility” are now applied. Those new trends have led to situations when patients are given by physicians the means to end their lives by themselves (physician-assisted suicide) or with the help of a health professional (euthanasia) to relieve patients' suffering. Several professional medical organizations (AMA, ACP, AAHPM, for instance) provide ethical guidelines and may help solve end-of-life clinical problems which sometimes present some of the most challenging ethical dilemmas.