Mike Brady
Journal of Paramedic Practice, Vol. 8, Iss. 1, 11 Jan 2016, pp 18 - 24

Currently patients at the end of life, for numerous reasons, often dial 999 when
they experience many symptoms that can impact upon their current quality of
life, such as pain and breathlessness. These calls regularly elicit a high priority
paramedic response, which when taken in context, may be inappropriate, and
can often lead to transportation to hospital, which itself can be inappropriate,
and or delay in the most appropriate care required. This is worsened somewhat
by sporadic or non-existent community palliative care coverage in various areas.
The concept of autonomy is key to patient care, but arguably more so at the
end of life. This article will review the available literature and recent evidence in
the context of an anonymised case study, to highlight how patient and family
autonomy can guide and support the decisions made by paramedics in these
cases, and the benefits and challenges this autonomy brings, in the current
social context of health care.
This case study aims to didactically explore the concept of an autonomous
good death through an anonymised example from practice. In doing so, it will
explore the surrounding concepts of advanced decision making, do not actively
resuscitate orders, mental capacity, a good death, and a good-enough-death,
and how autonomy guides all of these areas of care. in doing so paramedics
may be better able to respond to some of the challenge they face in clinical
practice, while attempting to provide the most appropriate care at the most
appropriate time to those at the end of life.

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