**5. Conclusion**

*Palliative Care*

ethically unacceptable.

**Protection of personal data**: in the Directive, protection of the personal data of the patients is deemed obligatory. Personal data comprise information about an individual's identity and also include information as to a patient's illnesses. The principle of non-maleficence to the confidentiality of the patients and their relatives entails respect for their private life. Members of the team providing palliative care services can share patients' personal or statistical data with the second or third parties or with the relevant institutions only to an extent that the patients permit. In the contrary cases, it can be stated that the individual's private life is not respected, and this means that respect for autonomy, which is one of the basic ethical principles, is violated. Therefore, such practices are

**Sixth section**

Patient Rights, Termination of Service, Training, Supervision and Responsibility

**Informing the patient and the patient's volunteering**: it can be seen that the Directive respects persons and pays attention to patient autonomy. The patient's volunteering for admission to palliative care is regarded as a value in line with the principle of respect for patient's autonomy. The patient's volunteering is based on the information given to the patient as to the content of palliative care service. Therefore, in the Directive, a special attention was attached to informing the patient. The basic reason for emphasizing its importance is to ensure that the patient rights, which are part of human rights specific to the field of medicine, are reflected on medicine in practice. Otherwise, the patient's volunteering might be at risk, and the patient's autonomy might be damaged. Giving incomplete information to the patient about the end-of-life or his/her chronical diseases, pressuring the patient, and deceiving the patient about the possible benefits of palliative care might impair the patient's volunteering; therefore, such practices are ethically unacceptable. In the delivery of palliative care services, healthcare professionals are expected to ensure that patients receive a care service compatible with human dignity in the challenging conditions they face. Moreover, the patients' giving of consent for the palliative care to be offered to them is based on the information given to them and making sure that it was fully comprehended by them. At this stage, the content of the information to be given to the patients demanding palliative care or their relatives is important. The understanding of what palliative care constitutes the "informing" phase of the process. Also referred to as "getting informed consent," the process is the reflection of the basic ethical principle of respect for autonomy on

**Refusal to healthcare**: in line with the principle of respect for autonomy, healthcare professionals who provide palliative care services should understand it when a patient refuses to receive care service on his/her own consent. Therefore, they should neither force patients or their families to receive palliative care services nor put pressure on patients in order to persuade them. The most ethically appropriate approach would be letting the patients make their own decisions as to the healthcare

services they will receive no matter how big their pain and suffering is.

*Article 16—(1) "Patients accepted to palliative care services shall be informed about patient rights and liabilities and the content of the service. The patient himself or his legal representative has the right to receive all kinds of information about the service to be provided and the risks (if any). And, the patient has the right to refuse the service. Legislation provisions regarding patient rights are reserved."*

**38**

the field of medicine.

As well as the principles that it recognizes, medicine is also renowned for the practices that it deems unacceptable on ethical grounds. Practices such as overlooking the health needs of patients with chronical diseases or terminal patients and disregarding their healthcare needs, for instance, are ethically unacceptable.

The conditions that patients or their relatives face might sometimes hinder them from pursuing a quality life. If they prefer, they can receive palliative care, which can give them a chance to have a fairly quality life. Palliative care is crucial for maintaining the confidence in medicine and cannot be considered separately from the medicine's duty to help.

In Turkey, how and by whom palliative care should be given to a patient approaching to the end of his/her life is determined by the relevant directive. Providing the service in line with the legislation and regarding patient rights, professional ethics, and medical deontology is essential. In palliative care centers, under the coordination of Provincial Directorate of Health, health services are provided in collaboration with local authorities, other health institutions in the region, universities, and with other related institutions. Besides, the centers also take the responsibility to contribute to the training of the society by means of planning trainings that go beyond the institution.

The fact that the Directive involves the doctrine of informed consent, which is the reflection of the principle of respect for autonomy on medical practices, illustrates the importance attached to patient rights in palliative care services. Nevertheless, there are still issues to be dealt with such as identifying the ethical dilemmas, which may emerge due to telling the patients and their relatives the truth, giving them the bad news, and decision-making for the end-of-life decisions, and taking measures in order to solve them. Ethical mistakes that healthcare professional make out of ignorance might be eliminated if their knowledge on the issues not covered in the Directive is reinforced through in-service trainings.

Early identification and assessment of life-limiting diseases match up with the raison d'être of palliative care services. In this context, palliative care aims to support both the patients and their family members who encounter such problems when it comes to life-threatening diseases. In order to identify the ethical problems seen in palliative care services in Turkey, qualitative and quantitative studies are needed to be carried out. As palliative care services become a more common practice in Turkey and more sophisticated solutions are offered as to the ethical problems encountered in practice, the structure of the palliative care service delivery will also go through transformation.
