A case study exploring the ethical and policy dimensions of allocating acute care resources to a dying patient.
OBJECTIVE
We aimed to identify policy, process and ethical issues related to allocation of National Health Service resources when patients with end-of-life illness are referred to acute care services.


BACKGROUND
Sharing healthcare decisions denotes a different partnership between professionals and patients when patients are empowered to define their needs. Implementation of a transition from professional to patient decision-making appears to be dependent upon its interpretation by personnel delivering care using the local trust policy. The outcome of this is a reformation of responsibility for budget allocation, choice of acute care provider and selecting services, currently in the realm of primary care; be it the general practitioner, community practitioners, or the patient.


METHODS
We used a 'lens' approach to case study analysis in which the lens is constructed of a model of policy analysis and four principles of biomedical ethics. A patient's decision to decline care proposed by an Accident and Emergency department nurse and the nurse's response to that decision expose a policy that restricts the use of ambulance transport and with that, flexibility in responses to patients' decisions.


RESULTS
End-of-life care partnership decisions require sensitivity and flexibility from all healthcare practitioners. We found that policy-based systems currently used to deliver care across the primary care - hospital care border are far from seamless and can lead to foreseeable problems.


CONCLUSIONS
Health professionals responsible for the care of a patient at the end of life should consider the holistic outcomes of resource allocation decisions for patients.


CONCLUSIONS
Government and health professional agenda suggest that patients should be given a greater element of control over their healthcare than has historically been the case. When patients take responsibility for their decisions, healthcare personnel should recognize that this signals a shift in the nature of the professional-patient relationship to one of partnership.
Cooke
Mary
M
Acute and Critical Care Nursing Department, School of Nursing and Midwifery, University of Sheffield, Bartolome House, Sheffield, UK. ciaran.hurley@sheffield.ac.uk
Hurley
Ciarán
C
D004636:Emergency Service, Hospital; D015276:Health Care Rationing / Q000941:ethics*; D006801:Humans; D019982:Organizational Case Studies; D016134:Organizational Policy; D010358:Patient Participation; D012017:Referral and Consultation; D013222:State Medicine; D013727:Terminal Care / Q000458:organization & administration*; D006113:United Kingdom