Barriers for Patients

As our population ages, there is an increase of people living with multifaceted and severe health conditions affecting their quality of life, as well as their families. The National Palliative Care Research Center states that by 2030, 20 percent of the population in the United States (U.S.) will be over the age of 65 and will have either developed one or more chronic diseases state that they will live with for years before death (‘NPCRC,’ n.d.). Palliative care is a plan of care for those patients who will continue to live with one or more serious or complicated illnesses.

It can be applied to many serious disease processes and can generally help lower healthcare costs by decreasing emergency department (ED) visits and re-hospitalizations for those disease processes. Palliative care also offers comfort that improves the relationship and quality of care between staff, patient, and their family. Unfortunately, patients most in need of this type of care currently cannot make that choice or they receive fallacious information.

Analysis of the Ethical Issue

The current medical ethics code provides support and guidance for sharing information amongst patients, theifamiliesly, and clinicians while supporting autonomy for all. However, it does not cover the complexities of caring for the multiple family members involved and how the scope of practice changes for those working with the patient and family as the disease process changes to end-of-life care (Rosenberg & Speice, 2013). Palliative carneedsof evidence-based research to become a more standardized option of care through insurance. Many in the field question the design, the approach, to ensure and nature of the research conducted, whether patients at the end of their lives should be invited to participate in clinical trials, and the veracity of patient informed consent due to restricted time and declining physical/mental capacities of the patients (Gysels et al.

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, 2013). Gysels et al. also suggested there are varying ideas regarding the ethical conduct of palliative care research and the lack of empirical evidence leading to a need to identify and arrive at best practices in this field of research (2013). Reinke & Meier addressed research gaps in identifying which critically ill patients/families would benefit from palliative care, which models of care are most effective, and what outcomes are most valid in determining the effectiveness of interventions in several areas of concentration. These areas include intensive care units (ICUs), heart failure, chronic kidney disease, and surgical and pulmonary disease patients. There is also the idea held by some, including the American Life League, that palliative care may be opening the door to physician-assisted suicide and euthanasia (Wensley, 2016). While not the true focus of palliative care, this point of view is worth mentioning for ethics’ sake.

Evaluation of ethical dimensions of public health options

Without the funding for research and educational opportunities, thousands of patients will miss out on receiving quality care when it is needed the most. The U.S. could use more current policies to ensure this funding. Both the House of Representatives and the Senate have sent bills concerning palliative care to other committees, with no movement since 2015/2016.U.S. state government is also involved in initiating policy, such as Florida’s Establishment of the Palliative Care Ad Hoc Committee (PCAHC) 2015 (Establishment of the Palliative Care Ad Hoc Committee, 2015). It is considered an advisory body to its Department of Health and evaluated the palliative care initiatives within the state. The PCAHC report evaluated the majority of Florida’s counties and found less than 50 percent sufficiency in both in- and out-patient settings. The PCAHC recommended strengthening the minimum standards for palliative care, increasing training opportunities for clinicians, and providing education on palliative care to the public and health care sectors (Sinclair & Meier, 2017).

Justification for one public health option

Palliative care has far-reaching effects for seriously ill patients, ranging from children to the elderly, as well as for their families. It can be provided for any stage of serious illness alongside curative treatment and is based on need, not prognosis (‘Care,’ 2016). Palliative care access in the U.S. is trying to catch up, but this need is expected to increase exponentially in the coming years. It will lead to lower medical costs due to chronic illness by decreasing ED visits, reducing hospitalization, and allowing patients to have a say or a goal for their disease process (‘Care,’ 2016). The patients who benefit from this have multiple morbidities, functional or cognitive impairment, ent or both. These conditions typically incur high costs yearly with hospitalizations and emergency department visits (Meier et al., 2017). Meier et al. explain that this type of patient has high levels of functional dependency and symptom distress, including pain and depression; their families have financial and social burdens of caregiving, and preventable symptom crises (2017). Palliative care programs have been shown to effectively improve all of the above-listed outcomes.

There are several barriers for patients and providers in accessing palliative care, such as workforce shortages, inadequate training, and insufficient organizational capacity (partially due to lack of payment programs) (Meier et al., 2017). But, it is the lack of public and professional awareness of palliative care benefits, the lack of regulatory requirements and accreditation standards to ensure access and quality, and the inadequate evidence base to guide safe and effective practices (Meier et al., 2017) that weakens the acceptance of this care practice within the medical community. As such, the U.S. should be striving the development of national strategies for palliative care, focusing treatments on the whole person and his or her family, based on informed care principles.