Academic journal article Australian Health Review

Ethico-Legal Issues in Relation to End-of-Life Care and Institutional Mental Health

Academic journal article Australian Health Review

Ethico-Legal Issues in Relation to End-of-Life Care and Institutional Mental Health

Article excerpt

Abstract

Objectives: In view of the fact that there is a higher mortality rate for individuals with serious mental illness and that people with mental illness suffer excess mortality due to physical illness, the lack of attention to end-of-life care for patients with a serious mental illness needs addressing. This article seeks to put these issues on the agenda by beginning to explore important ethico-legal issues at the interface of palliative care and institutional mental health.

Methods: Data were collected from eight qualitative interviews conducted with mental health professionals at The Park, Centre for Mental Health, Queensland. The interviews were recorded verbatim, coded and thematically analysed.

Results: The findings highlight the inherent tension at the interface of compassionate, patient-centred end-of-life care and the participants' perception of the legal restraints imposed by virtue of being in a mental health institution. This article examines the participants' perceptions of the legal restraints curtailing the provision of palliative care in a mental health institution and considers these findings within an understanding of the limitations imposed by law. Our hope and expectation in undertaking this exploration is to clarify the legal limitations that operate to restrict the type of end-of-life care that can be offered to mental health patients, in order to provide an informed basis for practice.

Aust Health Rev 2006: 30(3): 286-297

TO DATE, THERE HAS BEEN a loud silence on the topic of palliative care in relation to patients in institutional mental health facilities. Indeed, the only references to mental illness in the palliative care literature focus on the role of psychiatry for mainstream hospice or palliative care patients and their families.1-36 In the literature, the focus is predominantly on cancer patients with psychiatric problems, rather than individuals with a mental illness coping with cancer or other physical illnesses. There is scant consideration of terminal illness from the perspective of those diagnosed with a serious mental illness, particularly in regard to the problems such individuals encounter during their dying trajectory in the mental health system. In view of the fact that there is a higher mortality rate for individuals with serious mental illness5,6 and that people with mental illness suffer excess mortality due to physical illness,7 this lack of attention to end-of-life care for patients with a serious mental illness is difficult to understand. Not only are those with a serious mental illness more likely to experience premature death,8-15 they are at a heightened risk of death from suicide throughout their illness trajectory.16,17 In short, the close association between serious mental illness and dying argues for close attention to palliative care for this subset of patients. This article seeks to put these issues on the agenda by beginning to explore important ethico-legal issues for health professionals at the interface of palliative care and institutional mental health.

The ideology and philosophy of palliative care embraces a holistic, compassionate, person-centred approach for families coping with a member with a terminal illness. As defined by the World Health Organization,22 palliative care is:

The active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems, is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families.

Although palliative care is now understood as best practice for terminal care,18-21 the available evidence indicates that it is predominantly provided to cancer patients and accessed by the more privileged, middle-class, Anglo-Celtic patients who live in stable home environments with available caregivers and other supports.23-27 There is no literature on palliative care in the psychiatric or mental health setting. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.