A Shifting Paradigm: Ethical Challenges in C-L Psychiatry in End-of-Life Care. Co-sponsored by ACLP's Bioethics, and Palliative Medicine & Psycho-Oncology SIGs

Abstract: Over the last two decades, the role of psychiatric consultants in managing patients who express their desire to die has become considerably more complicated. CL psychiatrists are faced with the challenge of parsing out the underlying ethical principles embedded within end-of-life care while managing the psychological and moral distress often experienced by the patient, family, and healthcare team. As medicine and patient-centered care promote respect for patient autonomy while pulling away from paternalism, there is an expanding acceptance of an individual’s right to choose how to be cared for at the end of life. For clinicians providing end-of-life care, the intricacies of truth-telling and non-abandonment reflected by the principles of veracity and fidelity are central to ethically driven patient care. Unfortunately, these principles are frequently challenged by complicated multidisciplinary treatments, institutional or systemic constraints, and third-party payers.

Patients and families are often disappointed and psychologically distressed by disjointed, inconsistent care that departs from their expectations. CL psychiatrists are intimately involved in intense decisional capacity assessments, managing end-of-life psychiatric syndromes, and supporting caregivers and staff. Perhaps one of the most unique activities of contemporary CL psychiatrists is to assist in the care of medical aid in dying (MAID), also called by various other names. Since the Death with Dignity Act was implemented in Oregon in 1997, there are now ten states where MAID is legal.

This interactive symposium will present the ethical aspects of psychiatric involvement within difficult end-of-life care. Audience participation will be encouraged by the polling of key questions.

Dr. Mazur will present a troubling case of a terminally ill female whose end-of-life care was fraught with legal, ethical, and medical challenges. Recorded video of the patient will be used to enhance audience engagement.

Dr. Alici will review commonly encountered ethical challenges in the care of cancer patients and families facing end-of-life decisions, emphasizing the role of relational autonomy.

Dr. McFarland will present the problematic intersection of modern interdisciplinary cancer therapeutics and truth-telling/prognostication. He will highlight the relevant ethical principles and discuss how poor prognostication is psychologically distressing and challenges end-of-life care.

Dr. Tiamson-Kassab has significant experience assessing patients who have opted for MAID. She will describe the End-of-Life Option Act and examine several cases to illustrate the significant ethical challenges raised by MAID and how C-L psychiatrists working with these patients position their care accordingly.

This symposium is a joint effort of the Bioethics and Palliative Care/Psycho-Oncology special interest groups of the ACLP.