Ethical and Legal Decision-Making

Ethical and legal decision-making are integral components of palliative medicine. The four key principles of Western bioethics are autonomy, nonmaleficence, beneficence, and justice. In routine palliative care practice, withdrawing unwanted treatment is consistent with the principles of bioethics. Also, physician’s intent is the key to the doctrine of double effect as physicians administer treatments such as opioids for pain. This chapter highlights key topics addressing issues related to ethical and legal decision-making in palliative care including use of surrogates for decision-making, requests for assisted death, informed consent, and privacy concerns. The chapter also considers clinical concerns such as resuscitation status, nutrition and hydration, communication and culture.