The Evolution of End-of-Life Care – Ethical Implications for Case Management

Ellen Fink-Samnick , MSW, ACSW, LCSW, CCM, CRP


Purpose and Objectives: This article:

  1. discusses historic milestones of the death with dignity movement,
  2. provides legislation, reimbursement, and programming updates,
  3. discusses the infl uence of shared decision making, and
  4. explores ethical implications of the evolution of end-of-life care for case managers.

Primary Practice Settings(s): Applicable to all health care sectors where case management is practiced. Findings/Conclusion: Few topics are more intimate and multifaceted for case managers than engaging with today’s culturally diverse patient populations around end-of-life processes. The already prominent focus of this issue has been further elevated by a series of events to receive public attention. These include the Institute of Medicine’s 2014 report— Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life , rising numbers of patients around the globe requesting to end life on their own terms, and corresponding death with dignity initiatives and legislation. Another vital factor in the end-of-life equation involves how the latest generation of shared decision making influences the management of treatment dialogues among practitioners, patients, as well as insurance companies. Case managers are at the intersection of these complex interactions, working to achieve ethical, as well as legal accountability to the patient, employer, and profession while balancing personal perspectives. Implications for Case Management Practice: Professionals strive to effectively intervene with patients and their support systems facing end-of-life care decisions. It is essential case managers actively consider the intricacies of ethical practice and current contexts including death with dignity legislation, shared decision making, and shifts in regulations and reimbursement for end-of-life care. Case management’s ethical envelope will continue to be pushed. To that end amid shifting societal constructs, professionals must have mastery of applicable codes, standards, principles, and rules essential for adherence to ethical practice.
Key words: care coordination , case management , death with dignity , end-of-life , nursing , shared decision making , social work , transdisciplinary

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