ABSTRACT
This chapter introduces a framework for ethical clinical pragmatism in end-of-life care. This framework seeks to understand the specific context of the clinical decision, and enables the care team to consider care options with attention to patient preferences, open discussion, and legal imperatives. The chapter illustrates that the concepts of clinical pragmatism and discusses three important end-of-life issues that are commonly faced by palliative-care nurses, using case studies to illustrate the issues raised. These three issues are: the use of sedation; dealing with requests to hasten death; and working with differing desires for end-of-life care. Palliative care promotes the importance of comfort and quality of life, and emphasises that the direction of care is determined by the individual concerned. The underlying focus of all health care is the sick or dying person, and in palliative care the goal is principally the relief and prevention of suffering.
