Pasetti C
Comitato Etico Fondazione Salvatore Maugeri, IRCCS, Pavia, Italy.
G Ital Med Lav Ergon. 2008 Jul-Sep;30(3 Suppl B):B10-4.
This paper outlines the main instruments and contexts of applied clinical ethics in which the ethical issues of caregiving and the figure and role of the caregiver, far from being in apparent conflict, complement and influence each other reciprocally: i.e. Informed Consent and the end of life decision making processes regarding the activation and suspension of vital support means. These in fact are the two principal areas, though there are other scenarios in which the correspondence between bioethics and caregiving would equally come to assume great importance (e.g. the doctor-patient-caregiver relationship, palliative care, the approach to suffering, terminal sedation, home care and treatments). Attention is drawn in particular to one end of life issue that is often overlooked, i.e. favoring the caregiver's presence as the time of dying draws near and at the moment of death itself, a presence that involves high emotional involvement and has a high moral impact and that can give dignity and spirituality to an event that patients usually experience in solitude and in the absence of family members and health professionals. The paper, in conclusion, highlights that in modern scenarios of the ethics of caregiving, particularly regarding the care of patients with chronic progressive diseases with negative prognosis or of patients with limited or no decisional capacity, the role of the caregiver is fundamental both as an element of balance between autonomy and beneficence and as a guarantor of the patient's best interest and of their preferences, desires and values, not to mention the contribution caregivers make to the ethical discernment and sense of responsibility of health professionals.
