Major issues relating to end-of-life care Ethical, legal and medical from a historical perspective

Purpose - Ethical, legal and medical progress has been made in end-of-life care, addressing crucial issues in the application of principles to clinical cases. However, despite the progress, there are still unresolved issues concerning the scope and effectiveness of personal decision making and the proper use of last resort measures in terminal care. An analysis of the progress discloses both the advances and the problems still confronting patients and their families. From this perspective, one gains a better understanding of the reality of terminal care and areas that call for reform. Design/methodology/approach - A historical analysis reveals the interrelation between moral and legal reasoning and their differences. It also discloses developments in the moral and legal realms that recognize rights of the patient with regard to treatment decisions. A critique of ethical and legal reasoning and medical practice pin-points the salient problems. Findings - There are still problems in the application of legal and ethical principles to specific cases. These problems are complicated by poor physician-patient communication, the ineffective use of advance directives and the impact of the market economy on comprehensive palliative care. These call for reform to protect personal rights and dignity at the end of life. Originality/value - A historical approach, too often lacking, promotes insight into the complexities of end-of-life care. An analysis flowing from such a perspective pin-points not only the advances in ethical, legal and medical practice but also the flaws and inconsistencies that call for a more realistic approach in reasoning and practice.