We are pleased to present you with this special issue of Progress in Palliative Care devoted to ethics issues affecting our field. We have chosen a variety of articles to pique your interest – some theoretical, some practical, and all meant to challenge your mind and expand your horizons.
Palliative care and ethics have grown up together in medicine. As life changing and life prolonging technologies continue to expand, we have more need for both palliative care and ethics. Both fields continue to ask, not what can be done, but what should be done? Both fields recognize the wonders and challenges of technology, and both work to preserve and improve compassionate patient care in this brave new world.
We start with a provocative piece by Dr. Johnstone challenging the common assumptions that “luck” and “risk” are not part of ethical decision making at the end of life. Her argument forces us to ponder the implications of reliance on autonomy to achieve desired moral outcomes.
Dr. Azzam discusses with us decision-making capacity in the palliative care context, which is crucial in helping providers determine who is best able to help in decision making.
Surrogacy remains a difficult issue, so we have two papers on the topic. Dr. Sussman discusses the challenges of surrogacy with incapacitated patients. He points out criticisms and challenges of surrogacy and offers a defense of the surrogate's moral standing amid an explanation of authenticity.
Dr. Jimenez follows with the unenviable task of discussing inappropriate surrogate decision makers (SDMs). Although all of us have had to work with difficult surrogates Dr. Jimenez focuses on truly unacceptable SDMs - those operating beyond both the best interest and the substituted interest paradigms. He addresses approaches for use when all alternative dispute resolutions have failed.
Dr. Harter boldly takes on Medicare's failure to pay specifically for advance care planning (ACP). He argues that Medicare's decision to not offer an ACP benefit is not only economically unjust and unsound but violates basic tenets of medical ethics.
Finally we offer two papers on medical care at the end of life. Dr. Rainone first reviews multiple aspects of palliative sedation and suggests regulation of the practice to ensure the prevention of harm. Dr. Daly and I then argue cardiopulmonary resuscitation has no place in hospice care, and we offer an option for hospices that agree.
We hope you enjoy this issue, and we look forward to a robust discussion of these issues.