{"id":1094,"date":"2015-12-21T09:31:42","date_gmt":"2015-12-21T09:31:42","guid":{"rendered":"https:\/\/blogs.bmj.com\/case-reports\/?p=1094"},"modified":"2015-12-21T09:31:42","modified_gmt":"2015-12-21T09:31:42","slug":"palliative-care-in-an-ebola-treatment-centre","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/case-reports\/2015\/12\/21\/palliative-care-in-an-ebola-treatment-centre\/","title":{"rendered":"Palliative care conundrums in an Ebola treatment centre"},"content":{"rendered":"

By\u00a0Kristian Dye<\/strong><\/p>\n

Dhillon et al.<\/a> present a case discussing the care of a patient with Ebola, which demonstrates in a micro\"medical-563427_1280\"cosm some of the biggest issues facing healthcare providers in patients\u00a0with palliative or terminal care needs\u00a0\u2013 albeit in a particular extreme care environment.<\/p>\n

In the case, the patient is declared palliative and restarted on active management, before being considered palliative once again and passing away.<\/p>\n

These are issues which perplex physicians in all care settings.<\/p>\n

    \n
  1. When do we consider a patient for palliative
    \ncare only?<\/li>\n
  2. How can we reconcile differing beliefs and values within the team to deliver the best care for patients?<\/li>\n<\/ol>\n

    Deciding a patient is palliative<\/h2>\n

    This is an issue that continues to vex physicians the world over. Cardona-Morrell and Hillman<\/a> identify no less than 18 different scales and assessment tools available to attempt to guide these decisions, none of which are perfect.<\/p>\n

    Rightly, much of this effort is focused on identifying those within the population who are entering the end of life, and for whom discussions and decisions surrounding palliative care can help them to avoid invasive and unpleasant interventions \u2013 in the UK the Gold Standard Framework<\/a> is the current tool used in community settings.<\/p>\n

    The difficulty with many of these tools is that they are not well-suited to the kind of case presented here. The \u2018normally fit but acutely unwell\u2019 patient presents a real problem for prognostication \u2013 where patients in similar situations receive the same care, some will still die, others stage recoveries that would make Lazarus jealous. In these situations, how can we make clinical\u00a0judgement\u00a0without losing the\u00a0patient in the interest of treating clinical indicators?<\/strong><\/p>\n

    Team-based approaches in palliative care<\/h2>\n

    Palliative care is one of the areas of medical practice where personal values can have the biggest impact on the judgements physicians make. We all bring with us a multiple of baggage \u2013 emotional, cultural and religious \u2013 that colour our views.<\/p>\n

    A helpful summary of religious views on palliative care, by Steinberg<\/a>, demonstrates the breadth of both agreement and disagreement between major religions on this topic.<\/p>\n

    Alongside this, our practice has to be informed by the ethical principles underpinning medical care. Respect for autonomy, the duty to act in the patient\u2019s best interest and the duty not to harm our patients are all critical to decisions around palliation of the dying patient \u2013 and all are open to interpretation by the practitioner.<\/p>\n

    What approaches can we take to ensure that\u00a0judgement\u00a0are taken by consensus, objectively, and\u00a0within the context of the individual patient? <\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

    By\u00a0Kristian Dye Dhillon et al. present a case discussing the care of a patient with Ebola, which demonstrates in a microcosm some of the biggest issues facing healthcare providers in patients\u00a0with palliative or terminal care needs\u00a0\u2013 albeit in a particular extreme care environment. In the case, the patient is declared palliative and restarted on active […]<\/p>\n

    Read More…<\/a><\/p>\n","protected":false},"author":290,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[263],"tags":[],"class_list":["post-1094","post","type-post","status-publish","format-standard","hentry","category-global-health"],"yoast_head":"\nPalliative care conundrums in an Ebola treatment centre - BMJ Case Reports blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/case-reports\/2015\/12\/21\/palliative-care-in-an-ebola-treatment-centre\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Palliative care conundrums in an Ebola treatment centre - BMJ Case Reports blog\" \/>\n<meta property=\"og:description\" content=\"By\u00a0Kristian Dye Dhillon et al. present a case discussing the care of a patient with Ebola, which demonstrates in a microcosm some of the biggest issues facing healthcare providers in patients\u00a0with palliative or terminal care needs\u00a0\u2013 albeit in a particular extreme care environment. In the case, the patient is declared palliative and restarted on active [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/case-reports\/2015\/12\/21\/palliative-care-in-an-ebola-treatment-centre\/\" \/>\n<meta property=\"og:site_name\" content=\"BMJ Case Reports blog\" \/>\n<meta property=\"article:published_time\" content=\"2015-12-21T09:31:42+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.bmj.com\/case-reports\/files\/2015\/12\/medical-563427_1280-500x333.jpg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/case-reports\\\/2015\\\/12\\\/21\\\/palliative-care-in-an-ebola-treatment-centre\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/case-reports\\\/2015\\\/12\\\/21\\\/palliative-care-in-an-ebola-treatment-centre\\\/\"},\"author\":{\"name\":\"\",\"@id\":\"\"},\"headline\":\"Palliative care conundrums in an Ebola treatment centre\",\"datePublished\":\"2015-12-21T09:31:42+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/case-reports\\\/2015\\\/12\\\/21\\\/palliative-care-in-an-ebola-treatment-centre\\\/\"},\"wordCount\":429,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/case-reports\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/case-reports\\\/2015\\\/12\\\/21\\\/palliative-care-in-an-ebola-treatment-centre\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/case-reports\\\/files\\\/2015\\\/12\\\/medical-563427_1280-500x333.jpg\",\"articleSection\":[\"Global Health\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/case-reports\\\/2015\\\/12\\\/21\\\/palliative-care-in-an-ebola-treatment-centre\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/case-reports\\\/2015\\\/12\\\/21\\\/palliative-care-in-an-ebola-treatment-centre\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/case-reports\\\/2015\\\/12\\\/21\\\/palliative-care-in-an-ebola-treatment-centre\\\/\",\"name\":\"Palliative care conundrums in an Ebola treatment centre - 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