End of life issues essay

Care at the end of life Essay

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It is a fact that humans are born to die. What was once considered a natural part of life has changed to an experience that may be more painful for the patient, family, and caregivers due to the advances in medical care. New procedures have allowed life to be extended longer than ever before. The question is: has the dying experience improved? This paper will include a review of death and dying from the perspectives of the patient and caregivers. An unfortunate case will be discussed, and the organizational structure, culture, and governance that led to this situation will be reviewed. Recommendations for the changes necessary to prevent such cases in the future will be included.

Ms. Smith was a 66 — year — old female with breast cancer that had metastasized to her lungs and liver. She had two adult daughters who lived in her home town and one of them had a young child. Mr. Smith was a 70- year-old retired factory worker. Ms. Smith had gone through lengthy chemotherapy and radiation treatments that had left her weak and debilitated. She developed pneumonia and experienced a respiratory arrest. She was placed on a ventilator and was weaned off the ventilator after two weeks. She remained in the Intensive Care Unit (ICU). Her family stayed with her as much as the ICU visiting hours allowed, but she was often alone and told her family that she was in pain and wanted to die.

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The nurses were concerned about her pain needs, but were also worried that too much medication could cause another respiratory arrest. Ms. Smith languished in the ICU for two months until she did have another respiratory arrest and died without her family at her side. She and her family had agreed that she would not go back on the ventilator, and the physicians had written a Do Not Resuscitate (DNR) order. They had planned to move her from the ICU, but they hesitated to place her on a regular floor. Everyone involved in the case believed that it was not handled well, and a team was assembled to determine how to improve the care of the dying.

A review of the literature found that this institution was not alone with their concerns that the care of the dying needed to improve. Autonomy is one of the core bioethical principles that focuses on the right of every individual to make choices regarding health care decisions. Providers and caregivers spend a great deal of time instructing and coaxing patients to take control of their own health. But these providers are often surprised and upset when patients with life-limiting illnesses express a desire to control the timing and circumstances of their end-of-life experience (Volker, Kahn, & Penticuff, 2004). In their study, they found that people with advanced cancer expressed a wide variety of preferences for personal control and comfort, and that many wanted to remain as involved as possible in their daily lives for as long as possible.

Organizations can play a key role in policy changes to support the needs of these individuals. Providers are trained to see death as the enemy, and sometimes forget that death is a natural part of the human experience. Joe Cantlupe’s story in Health Leaders stated that “we don’t always deal with the issues of death and dying very well in our culture” (p. 14, 2013). The Institute of Medicine published a report that concluded that many patients die in pain, are not referred to hospice in a timely manner, and the improvements in care have not led to improvements in care at the end of life. Fortunately, there have been efforts to study the patient’s perspective of death and dying as well as the perspectives of nurses and physicians. These studies are leading to a better understanding of the experience and the methods needed to improve the quality of end of life care (Cantlupe, 2013).

It may seem strange to consider quality about end of life care, but it is recognized as an ethical obligation of health care providers and organizations. Singer, Martin, and Kelner studied 126 patients on dialysis, diagnosed with AIDS, or residents of long-term care facilities, to determine their views on end-of-life issues. Their results identified five domains of quality care at the end-of-life. These were “adequate pain and symptom management, avoiding inappropriate prolongation of dying, achieving a sense of control, relieving burden, and strengthening relationships with loved ones” (p. 163, 1999). The participants expressed fear of lingering or kept alive when they could no longer enjoy their lives. Many stated that they would not wish to go on life support if they were not going to improve or have a chance to live a normal life again. Several mentioned that being placed on life support was the same as being a guinea pig. There were conflicting reports on the choice of dying at home or in a hospital.

Some wanted to be at home, but others felt that was a burden on the family (Singer, Martin, & Kelner, 1999). Another study by Gourdji, McVey, & Purden in 2009 interviewed palliative care patients about the meaning of quality of life at this stage of their illness, and the factors that would improve their quality of life. They found that several factors, including their approach to life, their approach to their illness, and their ideal of quality of life shaped their end-of-life experiences. These patients stressed that they most wanted to continue what they had been doing for most of their lives for as long as possible. They also wanted to help others when possible and live in a caring environment. They often mentioned the use of humor and a positive attitude in the environment. When they discussed their illnesses, they expressed frustration with their physical limitations, and hopelessness when the disease reoccurred.

As providers began to understand the gap between their traditional training and the needs of patients, researchers began to evaluate the skills needed to provide a better quality of end-of-life care. Nursing had long considered the choices made about artificial nutrition or hydration, palliative treatment, or symptom control to be in the medical domain, and the nursing role was often unclear. Nursing is involved in the end-of-life care. They are with the inpatient on a 24-hour basis, they use a patient-centered approach to care, and they have experience and expertise in caring for dying patients and their families. Case studies have found that the nurses’ involvement in end-of-life care is not only about the technical decisions in the care process, but also that the daily interactions that nurses have with patient’s vulnerabilities make them ethically sensitive to the needs of the patient and family (Gastman, 2012).

The International Council of Nurses (ICN) developed a code of ethics that stated that nurses are responsible to alleviate suffering as well as promoting health and preventing illness. By expanding the scope of end-of-life care beyond the narrow medical definitions, and aligning the code of ethics with a broader definition of end-of-life care to expand beyond the hospital setting, nursing can become more involved in end-of-life care (Shigeko, Nague, Sakuai, & Imamura, 2012). The role of the primary care provider in end-of-life care has also been studied, and these studies have found that despite the continuity and comprehensiveness of primary care, few Americans die under the care of their familiar provider. Many patients have reported feeling abandoned by their primary care provider at the time of death. Care at home by primary care providers benefits many patients and the health care system overburdened by hospitalization cost (Silveira, & Forman, 2012).

On the other side of the care spectrum, the role of the intensive care provider also can be improved. White and Curtis (2005) studied the need and the impact of shared decision — making on critically ill ICU patients. They found that while involving families in end-of-life decisions is a complex task that requires excellent communication skills, the more time spent with families discussing and explain the issues, the higher the family satisfaction. The hospital where Ms. Smith died was the average institution with an organizational structure that included a Chief Medical Officer and Medical Directors of each specialty area. There was a Chief Nursing Officer as well as Nursing Administrators responsible for the care of patients. They had been very focused on treating illness, and considered themselves successful. The review by the improvement team helped them to see that they needed to change their perspective and consider less paternalistic alternatives to caring for patients at the end-of-life.

These alternatives usually save cost as well as providing better care at end-of-life. The reimbursement for palliative care programs has been slow, and this has prompted many hospitals to team up with local hospice programs or nursing facilities to decrease cost. Palliative care has been shown to extend the life of patients, reduce cost, and be more satisfying to the patient and family. Multidisciplinary teams that include physicians, nurses, social workers, psychologists, and spiritual counselors, work together to relieve the suffering, pain, depression, and stress that is often a part of chronic illness. These teams may also include nutritionists and therapist when needed by the individual patient. These programs listen to even the simple requests of patients and families. They work with the patient to get them to the best environment for them and to allow them dignity and control at the end of life. These teams are also moving to the outpatient area to prevent or decrease hospital admission and improve quality of life (Cantlupe, 2013).

Conclusion
Ms. Smith’s hospital should implement a multidisciplinary palliative care team. They should also add education to the program so that the patients and families are better informed about the results of care decisions such as ventilation, hydration, and nutrition. The hospital personnel need to be trained about palliative care and shift their paternalistic approach to a patient-centered approach. It is doubtful that Ms. Smith would have remained in the ICU for two months if there had been a palliative care program in place. She may have been able to transfer to an inpatient hospice center where her family could stay with her, and she would not have died alone and in pain.

End of Life Issues

After being diagnosed with debilitating diseases, such as one of the multiple forms of cancer or being in a Persistent Vegetative State, (PVS), many consider euthanasia to end the suffering of that individual. Euthanasia is defined as “the act of painlessly ending the lives of individuals who are suffering from an incurable disease or severe disability” (Santrock, 2012). The whole idea of euthanasia is to end the pain and suffering of a person instead of letting them go through the rest of their life awaiting a slow, painful, and oftentimes, undignified death.

The act of euthanasia is separated into two main categories; passive and active, or “letting die” and “killing”, respectively, according to Ansari, A. , Sambo, A. O. , & Abdulkadir, A. B. (2012). Passive euthanasia is when a person is allowed to die by withholding available treatment, such as an individual not performing CPR on a person who suffers from cardiac arrest or taking a person off their artificial life support system, like a feeding tube or breathing machine.

Euthanasia can be considered active when a person actively or deliberately gives another person a lethal injection to end their life. Another way to differentiate between the two types of euthanasia would be to say that active euthanasia occurs when an something happens to cause death to a patient and passive euthanasia happens when an inaction causes the patient to die. Physician-assisted suicide is considered a type of active euthanasia, which takes place when a doctor gives a patient a prescription or other drugs to let them to commit suicide.

To further classify the term, euthanasia, it can also be categorized as voluntary or involuntary. Voluntary is when a mentally competent person makes the decision to die on their own without being coerced and made fully aware of the pertinent facts of their health. Involuntary euthanasia, (or non-voluntary) is done without the consent of the patient, such as when the patient is in a coma, and the wishes of that patient are unknown.

To combat any moral or ethical issues about a persons’ decision to partake in euthanasia, or not partake for that matter, that individual should discuss their advanced care planning, or planned preferences for end-of-life care (Santrock, 2012). By evaluating how a person wants to live out the rest of their life, they can establish an advanced directive, or living will, which would indicate whether or not they wanted life-sustaining procedures used to prolong their life if death were imminent.

Any living will should only be signed by an individual that is in a coherent state of mind and able to think clearly (Santrock, 2012). The ethical issue raised by active euthanasia is that it could be considered used as a way to rid society of elderly or terminally ill patients whether they want to die or not. Patients may begin to fear that if they go to the hospital for even routine exams, they might not leave because a person on the medical staff might deem them unable to recuperate from whatever reason brought them to the hospital in the first place.

Proponents however, say that people are autonomous, that they have the right to make their own decisions about important issues in their lives such as death. An ethical issue raised by passive euthanasia is that it causes a person die slowly and painfully, instead of giving them the opportunity to pass away comfortably and on their own terms. The laws in Arizona state that any contributor participating in euthanasia would be guilty of one of the subheadings of homicide, being manslaughter, a class 2 felony, or first or second degree murder, both being class 1 felonies.

The state of Arizona believes that life is very important and nobody should be able to take that right away from any individual, barring any medical emergency procedure. I believe that euthanasia has its place in society. While I do not condone murder, I believe if a person is dying from an incurable disease or is in a persistent vegetative state where there is no chance of recovery, allowing that person to die painlessly and with dignity is more moral than not doing so.

Although human life is a precious gift from God, I feel that it would be the duty of the patients’ family and doctors to take all the information about the health of the patient and make the best decision for their loved one, even if the end result means the death of that person. Euthanasia has many angles to evaluate before a person commits to such an ultimate and final act, whether for a loved one or their own ending. A person

End of Life Issues Essay

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Euthanasia means “good death” but today the term is deemed as a merciful action to rid someone of suffering. In many cases we have seen terminally ill patients euthanized active or passive, yet for the sake of my essay I will discuss active euthanasia. End of life issues is a topic many families are faced with everyday more than one likes to imagine; however, imagine that you were a significant other who has a loved one in the hospital suffering from a terminal illness and their pain is unbearable that your loved one has decided to end his life and the subject of euthanasia comes up. What would you do? The first thought that would come to mind is that this is morally wrong and unacceptable in our society. I will talk about euthanasia and how three ethical theories presented in this course would better help answer your question of euthanasia being morally wrong. The moral theory of Immanuel Kant’s Deontology helps ethically with the views of euthanasia and the strengths and weakness of egoism and Utilitarianism will also be presented. This is where the deontological approach might help a family understand that it’s morally acceptable to comfort their loved one as he or she accepts active euthanasia as a means to end their life.

Deontology argues that an action is right or wrong in itself irrespective of the consequences and it is our duty our good will as Kant puts it to do the right thing. I ask the question what determines that right thing. Might it be religion and the word of god for those that believe in God or might it be for you several universal principles. Kant’s categorical says to Act in such a way that you treat humanity, whether in your own person or in the person of any other, always at the same time as an end and never merely as a means to an end. In other words, all people—including you—deserve respect. It would always be wrong to treat people as objects, or as a way of achieving some goal, or in another way that does not show respect. (Kant 1997, 1998) that we treat people as ends in themselves and not means to our ends.

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In other words we must respect the wishes of the patient. The strengths of Deontology as it relates to euthanasia is that the deontology argument is based on rules and an action is good if it follows the rule. The results doesn’t matter the only thing that matters is that we treat others with respect and love for that is something we should want for ourselves. The right to choose euthanasia is a right in its own and to also appeal to some natural laws when you say that a person “should be able to choose whether they live or die.” These are both rules. Your argument is that euthanasia is consistent with these rules and is therefore ethical. This is a deontological argument. Although, Kant held that if one commits suicide because one believes that the remainder of one’s life will be filled with more discomfort than pleasure, then one fails to treat oneself as an end and so long as one retains the capacities that would make you a person than one should always respect that life. Critics of deontology stated that the Kantian version seems too sterile and fails to capture some of the complex issues that arise when we confront ethical problems in real life (moser, 2013). The weakness to my argument as it relates to deontology and euthanasia is that taking your own life will not be morally acceptable in today’s society. With that being said, Kant did not believe in the outcome of an action or whether or not it’s ethical. When considering euthanasia, then, Kant will not be interested in the level of suffering of the patient or relatives. He would not agree that we should do the loving thing. He would work out what the right thing to do was.

With Kant’s categorical imperative Kant assumes that being a moral person is a requirement and Universalizing the maxim “I helping a love one to die” would give a universal law that everyone should be helped to die – a self-contradiction. If you took the maxim “I should help that love one, who is terminally ill, suffering unbearably and desperate to die, to die” you might create a more acceptable universal rule such as “Anyone who is terminally and incurably ill, suffering greatly and has freely chosen to die, should be helped to die”( rsrevision ). Also, some may say that deontology may require one to act in a way that seems obviously wrong and unethical. The deontologist maintains that some or all actions are right or wrong in themselves because of the type of action they are whether or not they produce the greater good. This type of view is less easy to systematize than the Consequentiality view. The second ethical theory The Egoist believes that the right action is always that which has the best consequences for the doer of the action, or agent. As with Utilitarianism, there are different versions of this doctrine according to whether the good consequences are seen in terms of maximum pleasure, minimum pain (Hedonistic Egoism) or in terms of other good consequences for the agent, such as his or her self — development or flourishing. At first sight, Hedonistic Egoism seems to prescribe a life spent trampling on anyone who gets in one’s way, and so to be ruled out as contrary to everything that is normally thought of as right. But ever since Plato philosophers have realized that in general human beings cannot maximize pleasure in that way.

Most people are not strong enough to do this with impunity, and in any case most people need friendship and cooperation with others for their own happiness. So Hedonistic Egoism cannot be dismissed quite so hastily. However, occasions would arise where Hedonistic Egoism, like Hedonistic Utilitarianism, demands ruthless action. For example, it would prescribe involuntary euthanasia to a doctor or caregiver who would gain a good deal from someone’s death, did not care enough about the victim to miss him personally and could conceal his deed from anyone who did. Such people, if rational, would not even feel guilty, for they would by their creed have done the right thing. A doctrine which prescribes this, even if on rare occasions, is too much at variance with our ordinary ideas of morality to be persuasive. However, Higher Egoism is another matter. For example, Aristotle’s doctrine is that the right policy in life is not to pursue our own pleasure but to develop our own flourishing or foster our best selves. And the best self is a non-egoistic self, who cultivates the kind of friendship in which friends are second selves and possesses all the moral virtues, including other-regarding ones such as generosity and justice. This kind of Egoism, instead of telling us always to pursue our own welfare, in a sense breaks down the distinction between self and others; we could not readily criticize it on the ground that it was obviously at variance with our ordinary moral views. On the other hand, it is not much use as a guide to action. We first need to know what kinds of action are virtuous in order to cultivate the virtues Aristotle speaks of.

The appeal of the Aristotelian approach today is not as a guide, but as a general framework in which one may set the moral life, and indeed all aspects of life. Aristotle thinks we cannot but pursue our own good as we see it, and perhaps he is right. But he aims to win us to a noble view of that good, in which our own true welfare is to be the best we can be. He lays stress on the distinctive nature of man and on the best life as one in which rational faculties are well exercised. The idea of a death with dignity, one in which these values are preserved, fits well with his outlook (Dr. Elizabeth Telfer, 2013). John’s Stuart Mill Utilitarianism is my third ethical theory that will be discussed here in our focus of euthanasia and whether or not it’s morally acceptable. One would consider when making a decision about euthanasia for an ill family member that according to Mill The utilitarian doctrine is, that happiness is desirable, and the only thing desirable, as an end; all other things being only desirable as means to that end. My interpretation is that in other words, we are to treat others and ourselves as a means to an end, and it would be immoral to use people and ourselves as a mere means. Happiness is something that can be experienced so far as we understand when we are alive. Mill also states that “… there is in reality nothing desired except happiness.

Whatever is desired otherwise than as a means to some end beyond itself, and ultimately to happiness, is desired as itself a part of happiness, and is not desired for itself until it has become so.”Utilitarianism seeks to find an answer to why people behave the way that they do, and according to Mill our actions derive from the pursuit of happiness. I would argue that according to utilitarianism that one does not commit suicide in order to seek happiness as an end. In conclusion, no one wants to be put in a situation where a loved one who’s terminally ill and is in unthinkable pain and therefore, has to makes up his or her mind to end their life through active euthanasia. I used deontology because the approach is very popular form of problem solving in ethical situations and egoism but Utilitarianism because it would give me comfort to know that I’m making the right decision morally for the patient and for selfish reasons. The three ethical theories are clear and easy to understand and frequently non ambiguous; however, right or wrong whether or not end of life decisions will be debated if not it’s morally accepted. I hope after analyzing these theories that I’m able to give comfort to someone that has to consider euthanasia for a loved one but I’m quite sure the debate will continue until as a society we come to accept that your life is your life and yours to do what you wish with it.