The Ethics of Prioritizing Access to Palliative Care: A Qualitative Study

Abstract

Palliative care services are increasingly required to consider issues of resource, management as demand for services increases. The processes of triage have been developed in health care as a means of balancing need and resources in an equitable and reproducible way.

Objective:

This article sought to explore ethical issues associated with prioritization decisions in palliative care.

Methods:

As part of a broader series of studies of triage in palliative care, this qualitative substudy was conducted via semi-structured focus groups and individual interviews. Transcripts were subjected to thematic analysis.

Setting/Participants:

Twenty health professionals working across disciplines (primary, specialist; medicine, nursing, and allied health), service types (inpatient, hospital liaison, and community), and locations (metropolitan and rural) in Victoria, Australia.

Results:

Four themes emerged from the data: (1) Clinicians understood the tension between maintaining service quality with the delivery of a compromised service that sought to respond to demand. (2) They were aware of the influences of relationships and responsibilities upon patient waiting list prioritization, and (3) reported a hierarchy of suffering with certain types of clinical problems viewed as more urgent than others, for example, pain being more urgent than existential distress. (4) Clinicians noted a lack of transparency around waiting lists as they currently exist.

Conclusions:

This study revealed key ethical decision-making issues associated with prioritizing access to palliative care services. Making explicit the processes and influences upon decision-making provides greater transparency of health-care utilization at the end of life.