title: Integrating care when the end is near: ethical dilemmas in end-of-life care.
abstract: An integrated and collaborative team provides the best clinical care of patients and families during end-of-life moments. Behavioral Health Clinicians (BHCs) bring a skill set for facilitating team interactions, attending to group process, as well as making space for the patient or family voice in the care, often with more time available for these roles. Through a case scenario, this article explores the relevant existing codes of ethics and professional conduct for professionals practicing in integrated care settings as they pertain to end-of-life transitions and care. Most notably, potential ethical issues pertaining to patient autonomy, scope of practice, confidentiality, multiple relationships, and record keeping all come to play during end-of-life care when practicing in an integrated primary care setting. Gaps in the existing codes are discussed and recommendations for providing ethically informed patient- and family-centered end-of-life care are suggested.
authors.affiliation: Department of Psychiatry, Institute for the Family, University of Rochester School of Medicine, Rochester, NY 14620, USA. tziporah_rosenberg@urmc.rochester.edu
authors.forename: Tziporah
authors.initials: T
authors.lastname: Rosenberg
authors.forename: Jenny
authors.initials: J
authors.lastname: Speice
mesh_terms: D000328:Adult; D001524:Behavioral Medicine / Q000941:ethics* / Q000379:methods / Q000458:organization & administration; D002983:Clinical Competence / Q000592:standards; D032781:Codes of Ethics; D003219:Confidentiality; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D007258:Informed Consent; D010348:Patient Care Team / Q000941:ethics* / Q000458:organization & administration; D057240:Patient Preference; D026684:Personal Autonomy; D011368:Professional-Family Relations; D012131:Respiratory Insufficiency; D012955:Societies, Medical / Q000592:standards; D013727:Terminal Care / Q000941:ethics* / Q000379:methods / Q000458:organization & administration; D014342:Truth Disclosure / Q000941:ethics