Ethical principles involved in care of dying patients, particularly in relation to - advocacy

What advocacy means

Advocacy in end-of-life care means actively representing and championing the dying patient's own wishes, values, and interests - particularly important as the patient's capacity to advocate for themselves may decline as they approach death
A core professional responsibility in palliative care, given the recognised power imbalance between an unwell, often vulnerable patient/family and the healthcare system, and the risk that a patient's voice can be lost amid competing family or institutional priorities

As physical and cognitive capacity decline near the end of life, patients become progressively less able to represent their own interests directly - advocacy by the clinical team (and by any appointed substitute decision-maker) becomes correspondingly more important to ensure the patient's previously expressed wishes continue to guide care

Effective advocacy requires actively eliciting and documenting the patient's wishes early, while they retain capacity, rather than waiting until a crisis point when the patient can no longer articulate them directly
Advocacy sometimes requires the clinical team to represent the patient's interests against family pressure (e.g. a family wanting more aggressive treatment than the patient has indicated they would want) or against system/resource pressures (e.g. premature discharge)

Document clearly expressed patient wishes and revisit them as circumstances evolve, ensuring they remain accessible to the whole care team, not held only in one clinician's memory
Support the patient's chosen substitute decision-maker to advocate effectively on the patient's behalf once the patient can no longer do so themselves

Advance care planning, substitute decision-making, family/patient conflict in goals of care

Advocacy is not the same as simply doing whatever the family requests - the clinical team's advocacy obligation is specifically to the patient's own wishes and best interests, which may at times differ from what family members, however well-intentioned, believe is best

5 more sections, plus exam facts

Premium unlocks every note across every specialty, and the full exam fact library behind it.