A good (enough) death: dissensus in end-of-life care

Abstract

Topics covered in this chapter A story from palliative care illustrates the role of dissensus (alongside consensus) in bringing together the elements of values-based practice to support partnership in decision-making. Other topics include: Multidisciplinary cancer care The National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) Transition from (surgical) cure to (palliative) care Spiritual and religious beliefs Advance care planning (ACP) in end-of-life care Consensus (in evidence-based practice) and dissensus (in values-based practice) Reminders of process elements of values-based practice (VBP flashbacks). Take-away message for practice Dissensual decision-making can help usx to build genuine partnerships in working with other team members and with patients and their families. Partnership between stakeholders in decision-making, although coming tenth in the list of process elements of values-based practice, is last but definitely not least in importance. We will see in this chapter that, as the tenth element, partnership draws together and underpins the process of values-based practice as a whole. The importance of partnership in values-based decision-making is illustrated in this chapter through the story of a 69-year-old man, Joe Monaghan, after he is found to have disseminated bowel cancer following an emergency admission with acute abdominal symptoms. There has been much talk in such situations of a “good death.” But the surgical team and Joe Monaghan's various family members, as we will see, had very different perspectives on what a “good death” would mean, with Joe Monaghan himself, as is so often the case, at risk of becoming caught between their conflicting best intentions.