A Comprehensive Guide to Building a Hospital-Based Palliative Care Program

Palliative care teams serve as an essential asset within hospitals, expertly addressing the multifaceted needs of patients, particularly those facing serious illnesses. Observing the Palliative Care Team at O’Connor Hospital during my Health Care Ethics Internship highlighted their crucial role in navigating the ethical complexities inherent in end-of-life care and decision-making. Biomedical ethics emphasizes core principles like beneficence, nonmaleficence, and autonomy, all of which are profoundly relevant to palliative care.

Research consistently demonstrates the positive impacts of palliative care programs on patients, their families, and the hospitals themselves. Despite these benefits, a significant gap exists: only about thirty percent of hospitals in America have established palliative care programs. The exemplary, patient-focused care I witnessed at O’Connor Hospital underscored the ethical lapse represented by this lack of widespread palliative care access. It’s a missed opportunity for hospitals to effectively alleviate suffering and meet the comprehensive needs of patients at a time when it is most crucial and achievable.

Palliative care operates on the fundamental principle of enhancing the quality of life for patients, even when curative treatments are not possible. This is achieved through a holistic approach that manages the physical, psychological, social, and spiritual dimensions of patient well-being, always respecting individual values, cultural backgrounds, and religious beliefs. Hospital-based palliative care is typically delivered by an interdisciplinary team of dedicated professionals, including doctors, nurses, psychologists, social workers, and chaplains. The necessity for these services in American hospitals is well-documented. Landmark studies like the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) have revealed significant shortcomings in end-of-life care in many hospitals, with in-hospital deaths often marked by poorly managed pain and prolonged suffering.

Palliative care offers numerous advantages for hospitalized patients, including specialized pain and symptom management, support in navigating difficult healthcare decisions, and assistance in defining care goals and suitable treatment strategies. In-patient palliative care enhances the coordination of patient care, ensures respect for patient autonomy, and strengthens communication between patients and healthcare providers. Ultimately, palliative care improves the quality of life for individuals facing progressive, incurable illnesses, aligning care with their personal values and preferences. Furthermore, palliative care contributes to hospitals’ efficiency by optimizing resource utilization, reducing hospital stays, facilitating timely and appropriate treatment, and minimizing the use of non-beneficial medical interventions.

Hospital palliative care services are vital in realizing the principle that “the task of medicine is to care even when it cannot cure.” Patients are entitled to the highest quality of healthcare throughout all stages of illness. The particularly intricate needs of patients nearing the end of life are best addressed through specialized palliative care programs. Hospitals bear an ethical responsibility to provide these programs, as beneficence and nonmaleficence principles compel them, alongside clinicians, to actively improve patients’ quality of life and alleviate suffering to the best of their ability.

Understanding the Ethical Imperative for Palliative Care

The Principles of Beneficence and Nonmaleficence

Beneficence, an essential ethical principle, dictates that healthcare actions should actively promote the well-being of others. This principle is inherently embedded in the roles of healthcare professionals, who commit to improving patient health and providing beneficial care daily. Similarly, nonmaleficence requires that healthcare practices avoid causing unnecessary harm or injury. While acknowledging that medical treatments carry inherent risks, patients expect healthcare professionals to be cautious, diligent, and thoughtful in their care delivery.

This ethical framework extends to hospitals and healthcare organizations. Hospitals are ethically bound to support their staff and manage operations to ensure patient safety, uphold patient rights, and promote high-quality healthcare. Organizations like The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) set national standards for healthcare quality, including effective pain management, for accredited hospitals.9 Most hospitals recognize these responsibilities, often stating in their mission statements a commitment to high-quality, patient-centered care. Consequently, patients admitted to hospitals with acute conditions have a reasonable expectation of receiving appropriate, high-quality healthcare.

The principles of beneficence and nonmaleficence are foundational to the ethical obligations of healthcare professionals, requiring them to minimize harm and maximize benefit for patients throughout their illness. These principles also apply to healthcare organizations, mandating that hospital management, financial operations, and clinical policies support patient-centered, high-quality care that is beneficial, minimizes unnecessary harm, and respects patient autonomy.

The Growing Need for Palliative Care

Palliative care is particularly crucial for patients with chronic, progressive illnesses, often focusing on end-of-life needs for patients and their families. Historically, palliative care has been predominantly associated with cancer patients, but research indicates that individuals with chronic illnesses face similar challenges, such as pain, fatigue, weakness, nausea, and weight loss.10 In fact, patients with chronic conditions may have unique palliative care needs compared to cancer patients due to the often prolonged nature of their illnesses.11 Chronic illness has been described as a “modern epidemic” and a leading cause of mortality and disability in the developed world. Despite the growth of hospice and home care services, a significant percentage of patients still die in hospitals.12 Common causes of in-hospital death, such as heart failure and end-stage respiratory diseases, highlight a substantial population in need of palliative care.13 The terminal phases of these chronic diseases are often unpredictable, frequently requiring pain and symptom management.14 However, patients with chronic illnesses are often referred to palliative care services very late in their disease progression, or not at all.15 Consequently, many patients with chronic conditions, like Mrs. Smith, reach the end of life without adequate physical, psychological, social, and spiritual support.

Moreover, studies reveal that high-quality, ethical healthcare has not consistently been provided to patients in the terminal stages of illness. The SUPPORT study (1989-1994) revealed deficiencies in end-of-life care in numerous hospitals. In-hospital deaths were often characterized by uncontrolled pain, prolonged suffering, and caregiver burden.16 These findings highlighted the urgent need to improve care for the dying, prompting research into the needs and expectations of patients and families at the end of life.17 Key factors identified as important include effective pain and symptom management, clear patient-physician communication, preparation for expected outcomes, a sense of life completion, clear decision-making processes, and being treated as a “whole person.”18

These elements are crucial across all healthcare settings. The inherent dignity of each person compels healthcare professionals to treat patients holistically and to actively alleviate suffering whenever possible. However, research continues to show that many healthcare professionals lack the necessary expertise in palliative care and end-of-life issues.19 As a result, the diverse needs of hospitalized patients remain unmet, and their ethical rights are often overlooked.

Current literature strongly advocates for clinical teams to proactively address the needs of patients with chronic diseases by adopting a palliative care approach earlier in the illness trajectory.20 Healthcare organizations must support these clinical teams. Palliative care has been proven to significantly enhance the quality of life for patients with chronic illnesses and those nearing the end of life.21 Hospitals should prioritize educating healthcare professionals about palliative care and end-of-life issues, while management and policies should embody and promote the principles of beneficence, nonmaleficence, and autonomy. Implementing in-patient palliative care services is an ethical obligation for hospitals to ensure the provision of quality care.

Upholding Patient Autonomy

Palliative care services are also crucial for safeguarding the autonomy of patients with chronic illnesses. The principle of autonomy affirms the ethical right of individuals to make their own decisions and have those decisions respected.22 It emphasizes the inherent worth of each individual and their capacity to determine what is in their best interest. Respecting patient autonomy requires healthcare professionals and hospitals to honor patient choices and actions without unnecessary interference.23 Autonomy is fundamental to all healthcare decisions but is particularly critical for patients with incurable, progressive illnesses where treatment choices are less clear-cut and heavily influenced by personal values and preferences.

Unfortunately, patient autonomy is frequently disregarded or undervalued in end-of-life care. The SUPPORT study revealed instances where life-prolonging measures were used despite being medically ineffective and unwanted by patients and families. Other studies have shown cases where patients’ preferences to forgo resuscitation were completely ignored.24, 25 Palliative care services can help refine and enforce hospital policies and procedures that uphold patient autonomy. Such policies might include initiating advance directives, establishing guidelines for Do-Not-Resuscitate (DNR) orders, supporting comfort care protocols, and providing care for patients in comas or persistent vegetative states.

Key Goals of Palliative Care Programs

In alignment with the ethical principles of nonmaleficence, beneficence, and autonomy, the core goals of palliative care are distinctly patient-centered. These goals are: (1) to achieve and sustain the highest possible quality of life for patients, (2) to alleviate pain and suffering through expert symptom and pain management, and (3) to guide and support patients or their surrogate decision-makers in establishing appropriate care goals. Palliative care also encompasses other important goals such as providing practical support for families and caregivers, coordinating hospital and community resources, and educating and supporting hospital clinicians. While significant, these additional goals are secondary to the primary focus on the direct ethical obligations to the patient.26

Enhancing Quality of Life

Striving for and supporting the best possible quality of life is a fundamental aim of all healthcare. Illness or injury inherently diminishes quality of life. A primary goal of medicine is “to restore, maintain, or improve quality of life.”27 Achieving this involves understanding what “best quality of life” means for each individual patient. Quality of life is inherently subjective and can only be accurately defined by the person experiencing it. For a patient with a broken arm, the path to improved quality of life is clear once the fracture heals.

However, for patients with chronic, incurable illnesses, maximizing quality of life is more complex. Individuals with the same illness may have vastly different perceptions of what constitutes a good quality of life. Some might aim for a tolerable existence, while others seek a quality of life exceeding mere survival. Achieving the “best” quality of life might mean attaining an ordinary life or a meaningful life.28 Each of these concepts is shaped by the patient’s personal evaluation of their desired quality of life.

Furthermore, quality of life extends beyond physical health. Factors such as reduced health status, loss of independence, social isolation, family burden, limited resources, depression, and future anxieties can significantly lower the quality of life for terminally ill patients with chronic illnesses.29 A comprehensive view of quality of life includes physical, psychological, social, and spiritual dimensions of well-being.30 There is no universal standard for quality of life as it is shaped by personal experiences, beliefs, expectations, and perceptions.31 Moreover, a patient’s perception of quality of life can evolve as their illness progresses. Therefore, palliative care continuously adapts to changing patient preferences to support the best possible quality of life for each individual. Palliative care teams collaborate with patients, their healthcare teams, and families (when appropriate) to identify patient preferences, paying close attention to their values, goals, priorities, and cultural and spiritual perspectives.32

Maintaining quality of life becomes increasingly crucial as palliative care patients approach the terminal phase of illness and the end of life. American culture often lacks adequate preparation for dealing with death and dying, and within a hospital system primarily focused on curative treatment, death can be perceived as a failure.33 A vital aspect of palliative care is to recognize dying as a natural process and to facilitate a peaceful death for patients.34 The End-of-Life Nursing Education Consortium (ELNEC) defines a peaceful death as one free from suffering, allowing for life closure, and consistent with the patient’s wishes and beliefs.35

Achieving this primary goal of supporting patient quality of life is ethically imperative because actions or omissions that undermine quality of life can cause physical and emotional harm. Presuming to know a patient’s desired quality of life without direct communication violates patient autonomy and dignity. Ignoring personal, cultural, and religious viewpoints can inflict psychological, social, or spiritual harm.36 A hallmark of palliative care is its integration of psychological, social, and spiritual aspects of healthcare with physical care. Hospital in-patient palliative care services coordinate various hospital resources and departments to deliver quality patient care and fulfill the ethical duty to provide beneficial care that respects patient autonomy.

Relieving Suffering

The second key goal of palliative care is deeply connected to the first: alleviating suffering is essential to achieving the best quality of life. For many, this primarily means managing pain and distressing symptoms. While pain and physical symptoms contribute to suffering, they are not synonymous; not all suffering is painful, and not all pain causes suffering. Suffering can encompass physical and psychological symptoms, existential concerns, and empathetic distress for others.37 Like quality of life, pain and suffering are subjective experiences influenced by social and religious backgrounds. Some patients may even find certain aspects of suffering to be positive, particularly in their search for meaning and closure towards the end of life.38 Nevertheless, aggressive pain and symptom management remains a core objective of palliative care, as implied by its very name. Palliate means “to reduce the violence of (a disease)” and “to ease (symptoms) without curing the underlying disease.”39 While completely eliminating suffering may be impractical or impossible, palliative care aims to alleviate suffering – whether physical, spiritual, existential, or social – when possible and desired by the patient.

Relieving physical pain and symptoms is a particular strength and ethical duty of palliative care. Pain is the most common and feared symptom among hospital patients. Studies indicate that up to fifty percent of terminally ill patients experience moderate to severe pain for a significant portion of their remaining time.40, 41 Failing to relieve pain and other distressing symptoms when the capacity exists to do so harms the patient and violates the principle of nonmaleficence. Untreated pain can lead to medical complications, prolonged hospital stays, and decreased physical independence, all contributing to unnecessary suffering.42 Uncontrolled pain can also compromise patient autonomy by impairing competent decision-making.

Limited understanding of pain and symptom management is a known barrier to effective palliative care in hospitals.43 Healthcare professionals may under-medicate due to fears of addiction or because some analgesics can cloud patient consciousness. However, under-medication is itself unethical as it prolongs or inadequately relieves pain. Jonsen et al. in Clinical Ethics state:

Patients should not be kept on a drug regimen inadequate to control pain because of the ignorance of the physician or because of an ungrounded fear of addiction . . . [S]ensitive attention to patient’s needs, together with skilled medical management, should lead as closely as possible to the desired objective: maximum relief of pain with minimal diminution of consciousness and communication.44

In reality, addiction to pain medication is rare, and despite the subjective nature of pain, over ninety percent of pain episodes and other symptoms can be effectively managed with standard analgesic therapies.45, 46 To provide comprehensive pain and symptom management, hospitals need to employ physicians and nurses with specialized expertise in this area, dispel myths about analgesic addiction, and educate staff on recognizing and treating pain and distressing symptoms. Implementing a hospital-wide palliative care program is the most effective way to achieve these goals. Early control of pain and symptoms helps maintain patient independence and autonomy, providing significant benefits and avoiding unnecessary harm.

Beyond physical pain, palliative care also addresses the psychological, social, and spiritual dimensions of suffering. Worry, anxiety, and depression are common symptoms in advanced illness, and neglecting psychological and spiritual needs can intensify suffering.47 Psychologists and chaplains play crucial roles in helping patients cope with losses, such as independence and bodily control.48 Palliative care offers a supportive environment for patients to address fears and anxieties related to terminal illness and the dying process.49

Establishing Goals of Care

The third crucial goal of palliative care is to guide and assist patients or surrogate decision-makers in establishing appropriate goals of care and advance care planning. Like Mrs. Smith, many patients are hospitalized due to acute health crises, forcing them and their families to confront the reality of their illness and make critical decisions about future care. As patients face progressive, incurable illnesses, the current healthcare system often struggles to facilitate smooth transitions in care goals.50 Many individuals lack documented advance healthcare directives, and approximately fifty percent of DNR orders are written within two days of death.51 This indicates that many patients receive aggressive treatments in late stages of illness, treatments that may not prioritize quality of life or align with patient values and wishes.

However, simply having an advance directive is not sufficient. Research shows that increased documentation of patient preferences does not automatically translate to improved end-of-life care.52 Instructional advance directives document preferences for specific procedures, but they are often limited to particular treatment scenarios and may not apply to the complex medical decisions at the end of life.53 While advance directives aim to respect individual values and beliefs, they cannot be the sole guide for healthcare decisions, especially at life’s end. End-of-life values are not static; they can evolve over time and with changes in perceived quality of life.54

Nevertheless, advance care planning and establishing goals of care are essential because they empower patients with greater control over their healthcare and ensure autonomy if they become unable to communicate their wishes later. Patients want a voice in their care; they want to understand what to expect and how to plan for their treatment and future.55 Establishing care goals early helps prevent unnecessary harm and inappropriate prolongation of dying. Interventions focused solely on “curing” dying patients often increase suffering with minimal or no benefit.56 This suffering can extend beyond the patient. Nurses also face ethical and emotional challenges when care for dying patients emphasizes technology over comfort and quality of life.57 Moreover, a significant percentage of relatives may develop physical illnesses due to the stress of coping with a loved one’s poor health.58

Effective advance care planning and setting appropriate goals for patients with chronic illnesses rely on thorough, clear, and ongoing communication among the clinical team, the patient, and their family. Palliative care significantly facilitates this communication through family meetings. Palliative care teams are adept at promoting informed choices by clarifying priorities and enhancing understanding of diagnoses and prognoses for patients and families. This process strengthens the patient-physician relationship and fosters trust in the healthcare system by ensuring well-monitored, well-communicated care that aligns with patient values and ethical principles.

Step-by-Step Guide to Building Your Program

Creating a hospital-based palliative care program requires careful planning and execution. Here’s a step-by-step guide to assist in the development process:

1. Conduct a Needs Assessment:

   • Analyze Hospital Data: Review hospital data to identify patient populations who would benefit most from palliative care. This includes patients with chronic illnesses, high readmission rates, long lengths of stay, and those in intensive care units.
   • Stakeholder Interviews: Conduct interviews with physicians, nurses, social workers, chaplains, administrators, and ethicists to understand current perceptions of palliative care needs and existing resources within the hospital.
   • Patient and Family Feedback: If possible, gather feedback from patients and families about their experiences with end-of-life care within the hospital to identify areas for improvement.

2. Define Program Goals and Objectives:

   • Mission and Vision: Develop a clear mission and vision statement for the palliative care program that aligns with the hospital’s overall mission and values.
   • Specific Objectives: Set measurable objectives, such as reducing hospital length of stay for palliative care patients, increasing patient and family satisfaction, improving symptom management scores, and increasing hospice referral rates.
   • Scope of Services: Determine the range of services the program will offer, such as pain and symptom management, psychosocial and spiritual support, advance care planning, and family support.

3. Develop the Program Structure:

   • Interdisciplinary Team: Establish an interdisciplinary team that includes physicians, nurses, social workers, chaplains, and potentially pharmacists, psychologists, and other specialists. Define roles and responsibilities for each team member.
   • Service Delivery Model: Decide whether the program will operate as a consultation service, a dedicated palliative care unit, or a hybrid model. Consider the hospital’s size, resources, and patient needs when making this decision.
   • Policies and Procedures: Develop clear policies and procedures for patient referral, admission criteria, documentation, communication protocols, and ethical decision-making.

4. Secure Administrative Support and Resources:

   • Leadership Buy-in: Obtain strong support from hospital administration and leadership. Present the ethical, clinical, and financial benefits of palliative care to gain their commitment.
   • Financial Planning: Develop a budget for the program that includes staffing costs, training, equipment, and operational expenses. Explore funding sources, such as hospital operating budgets, philanthropy, and grants.
   • Resource Allocation: Ensure adequate resources are allocated, including office space, equipment, access to electronic health records, and support from other hospital departments.

5. Implement the Program:

   • Pilot Program: Consider starting with a pilot program in a specific unit or department to test the program model and refine processes before full hospital-wide implementation.
   • Communication and Marketing: Develop a communication plan to inform hospital staff, patients, and the community about the new palliative care program. Highlight its benefits and how to access services.
   • Integration with Existing Services: Ensure seamless integration of the palliative care program with other hospital services, such as oncology, cardiology, and critical care.

6. Staff Training and Education:

   • Initial Training: Provide comprehensive initial training for all palliative care team members, focusing on pain and symptom management, communication skills, ethical and legal issues, and interdisciplinary teamwork.
   • Ongoing Education: Implement ongoing education and professional development opportunities to keep the team updated on best practices in palliative care.
   • Hospital-Wide Education: Offer basic palliative care education to all hospital staff to promote a palliative care philosophy throughout the institution.

7. Evaluate and Improve Program Effectiveness:

   • Data Collection: Establish systems for collecting data on program outcomes, such as patient satisfaction, symptom control, length of stay, cost savings, and hospice referrals.
   • Performance Metrics: Track key performance indicators (KPIs) to measure program effectiveness and identify areas for improvement.
   • Regular Review: Conduct regular program reviews with the palliative care team and stakeholders to analyze data, discuss challenges, and make necessary adjustments to improve program performance and outcomes.

Benefits of a Hospital-Based Palliative Care Program

Improved Patient Outcomes and Quality of Life

Palliative care has consistently demonstrated its ability to provide high-quality, patient-centered care that aligns with individual values and preferences, effectively addressing the episodic and long-term nature of chronic illnesses.60

• Expert Symptom Management: Palliative care teams excel in managing pain and controlling a wide range of distressing symptoms, including fatigue, anxiety, breathlessness, nausea, and depression.61
• Enhanced Decision-Making: Palliative care facilitates difficult healthcare decisions by engaging patients and families in goals-of-care discussions and developing comprehensive treatment plans.62 These discussions often occur earlier in the course of illness when palliative care services are involved, leading to more appropriate and timely treatment plans.63
• Improved Patient-Physician Communication: Palliative care strengthens communication between patients and their healthcare providers, ensuring care is focused on the patient’s quality of life and personal values. Patients receiving palliative care consistently report high levels of satisfaction with their care.64

Enhanced Hospital Efficiency and Cost-Effectiveness

Significant resources are allocated to the care of seriously ill patients. With an aging population, the financial strain on hospitals is projected to increase. Palliative care offers a solution that is both high-quality and fiscally responsible.

• Reduced Length of Stay: In-patient palliative care services have been shown to decrease hospital length of stay, particularly in intensive care units.67 By focusing on quality of life and patient preferences, palliative care ensures patients are placed in the most appropriate level of care, avoiding unnecessary prolonged hospitalizations.
• Efficient Resource Utilization: Palliative care programs often lead to a reduction in the use of non-beneficial resources.68 Care plans developed with palliative care teams expedite appropriate treatment, avoiding redundant, unnecessary, or ineffective tests, procedures, and medications.69
• Systematic Approach to Complex Needs: Hospital palliative care programs provide a structured approach to managing patients with complex, high-intensity needs.70 Referral to palliative care ensures these patients’ needs are matched with the appropriate healthcare resources within the hospital.
• Improved Care Transitions: Palliative care facilitates smoother transitions between care settings, ensuring continuity of quality care upon discharge and reducing the likelihood of repeat acute hospital admissions.71 Palliative care programs also significantly increase hospice referral rates for patients who are not responding to curative treatments or who decide that the burdens of treatment outweigh the benefits.72

These benefits translate to decreased costs for hospitals and healthcare providers, alongside increased satisfaction among clinicians, patients, and families. Palliative care programs support hospital staff, enhancing job satisfaction and retention by helping them provide well-coordinated, patient-centered care.73 Ultimately, providing patient-centered care boosts patient and family satisfaction, fostering loyalty to the healthcare institution.74

Case Study: Mrs. Smith and the Impact of Palliative Care

To illustrate the profound impact of palliative care, let’s revisit the case of Mrs. Smith. Without palliative care, Mrs. Smith’s hospital experience was marked by inadequate pain and symptom management, poor communication, and uncoordinated care that failed to address her physical, psychosocial, and spiritual needs.

In a scenario where a palliative care service is available, Mrs. Smith’s experience would be significantly different. Upon admission, the healthcare team would recognize her history of COPD and diabetes, along with her pain and symptom concerns. Given her recent readmission, a proactive discussion about goals of care and advance care planning would be initiated. The Palliative Care Team would be consulted early to assist with symptom management and care planning.

Mrs. Smith would receive effective pain medication and oxygen to manage her symptoms and improve her comfort. A family meeting, involving Mrs. Smith, her family, and the Palliative Care Team (physician, nurse practitioner, social worker, and chaplain), would be held while she could still communicate. This meeting would explore her personal values and care goals, allowing her to express her wishes regarding heroic measures and end-of-life preferences.

When Mrs. Smith’s condition worsened and her pneumonia did not respond to antibiotics, the healthcare team, guided by her previously expressed wishes, would discuss the option of ICU transfer with her family. Respecting Mrs. Smith’s desire to avoid aggressive interventions, the family would decide against ICU transfer, comforted by the knowledge that her comfort was prioritized and her wishes were being honored. The Palliative Care Team would reassure the family that declining aggressive interventions was not hastening death but allowing a natural process.

With the support of the Palliative Care Team, Mrs. Smith and her family would make informed, clear decisions, avoiding a stressful ICU transfer. The chaplain would arrange for her parish priest to administer sacraments, and her family would gather to say goodbye. When Mrs. Smith experienced respiratory distress, her pain and symptoms would be effectively managed without intubation. She would die peacefully, surrounded by her family and a caring healthcare team who understood and honored her wishes.

This revised scenario demonstrates how palliative care effectively supports quality of life for patients with prolonged illnesses. Through its interdisciplinary, holistic, and patient-centered approach, hospitals with palliative care services fulfill their ethical obligation to provide quality, beneficial care to all patients.

Conclusion: Embracing Palliative Care as an Ethical and Practical Imperative

Hospital palliative care services are essential for embodying the principle that “the task of medicine is to care even when it cannot cure.”75 Patients with chronic, incurable illnesses deserve the highest quality of healthcare, and palliative care programs are the most effective way to meet their complex needs. By fostering ongoing, comprehensive communication that addresses the physical, emotional, social, and spiritual dimensions of patient well-being, palliative care teams support the best possible quality of life for all patients.

Developing a palliative care program in a hospital represents a relatively low start-up investment with immediate and significant impact. According to the Center to Advance Palliative Care, the financial benefits of such programs often outweigh the direct costs.76, 77 Palliative care services enable hospitals and healthcare providers to fulfill their ethical obligations to patients by providing beneficial care, minimizing harm, and protecting patient autonomy. The ethical principles of nonmaleficence, beneficence, and autonomy mandate that hospitals integrate the palliative care philosophy into the cure-focused healthcare system by developing robust, in-patient palliative care services.

References

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Stephanie C. Paulus wrote this paper as her senior honors thesis at Santa Clara University.