End of Life Issues Essay

Last year 23 September 2012. I had a resident called “Mrs X” she was a 72year-old widowed living at ---, a Nursing Care Home. She’s not a religious type of person as she was Atheist. She has lived in the home for the past two years, and during that time I was assigned as her key worker. Mrs X had One Son and 3 grand daughters they are all regular visitors to the home. She has recently been diagnosed with renal failure, and her life expectancy is only a couple of months without dialysis. In the past Mrs X has made it clear that when her “time comes” she wants to be able to stay at Belmont House, and “go quietly”. She has stated that she does not want any treatment that will prolong her life. This means

they can offer a wealth of information and can help to make them feel useful.

2) If the patient is not legally deemed competent to make his or her own medical decisions then an appointed guardian, next of kin, or power of attorney must provide consent on behalf of the patient, unless it is an emergency situation in which the health care providers must act fast, based on the case of Schloendorff v. Society of New York. In the case of an emergency the medical team may necessary care to keep the patient safe and sustain his or her life.

Ms. W has already had an abortion at the age of 15 and also has a baby that is 10 months of age. Ms. W is started on a standard intravenous medication that stops pre term labor (magnesium sulfate). Two days later Ms. W tell her Doctor named Dr. C that she was “tired of being in the hospital and the medications and the fetus were too painful and uncomfortable.” Dr. C explains to the patient the risk of premature delivery such as respiratory immaturity neurological handicaps etc. Dr. C also explained that if she stayed on the medications for another two to three weeks the chances of survival of the baby would be much higher, reducing the risk of chronic lung disease from fifty percent to ninety percent and from fifty percent to twenty percent respectfully. Ms. W still refused treatment and Dr. C ordered a psychiatry consult for Ms. W and she was found to be “extremely immature, emotionally labile and unrealistic.” She has also presented with suicidal thoughts and was known to be an illegal drug abuser in the past but not recently. She continued to refuse the medication to stop labor and threatened to leave the hospital. This is where Dr. C has to make a choice of what he should do. He comes up with three possible solutions, the first is to let the patient do as she pleases and stop giving the treatment, second if he does not want to force her to take the medication and does not want to force her to take them he can send her to another physician he knows will force her

ed. For the immense number of ill patients, the solution to their suffering is predominately quality sedative care, of which I ardently encourage. Though there are ill patients who seek sedative care, there is a significant amount of terminally ill patients for whom palliative care is not the solution and who suffer tremendously until they die. These are the type of patients who wish to end their suffering by making the decision to end their lives with the assistance of doctors. This also allows them to end their lives with dignity, and place of their choice. The only way to prevent suffering of this amount is to revise the law so patients are allowed to lawfully receive assistance to peacefully pass away.

They got her a stable heart rhythm, so she never had a chance to consent to anything. The patient is currently in a state incapacity. There is not preference found or submitted to the hospital stating the patient treatment preferences. The appropriate surrogate to make decisions for the patient is her three adult children. The patient’s kids have the right to make the decision because she doesn’t have a living will or appointed anyone to make medical decision for her. I understand each state has guidelines to follow in a situation like this on who to consult in a situation like this. Some states may follow the same hierarchy plans as Washington State which are included in this order legal guardian, individual with power of attorney for health care decisions, spouse, adult children (all in agreement), parents of patient, and adult sibling (all in agreement). The patient cannot state whether she is unwilling or unable to cooperate with treatment (Clarence H. Braddock III, MD, MPH, 1998).

Ms. Dennis has been diagnosed with the type-1 diabetes mellitus twenty-one years ago. She has been on insulin therapy since then, however despite the adherence to the therapy, she was frequently hospitalized due to the ketoacidosis episodes. After she joined the diabetic program, she was better able to manage her life-style choices which help her to accomplish better therapeutic outcomes. Regrettably three years ago, Ms. Dennis went through a dreadful divorce followed by a loss of her executive position. Since then, she has been noncompliant with her insulin therapy as well as with her lifestyle modifications. She started to abuse alcohol and due to the poor diet choices, she also gained a lot of weight. The poor management of her disease state lead her to the frequent hospitalizations. Ms. Dennis’s physician referred her to a psychiatrist. The psychiatrist recommended a behavior modification treatment which she completed, however, the treatment did not deliver a desired outcome. The physician becomes frustrated with her and considers severing the patient-physician relationships. However, before he does so, he contacts me, the pharmacist in charge of the diabetic counseling clinic, and asks me to help Ms. Dennis to manage her diabetes. The physician stresses that if I will not be able to get her to be compliant with the therapy, she will definitely die. I agree to it. However, despite coming to the clinic regularly for a year, Ms.

Grief is an acknowledgement that we loved someone, and the nature of our relationship with that person determines how we grieve. Grief is an exclusive process; one that is as different as the person experiencing it is. As Hospice volunteers we must respect each person’s individual grieving practices and refuse to give in to the temptation to advise others to follow our exact paths. Although those of us who have also experienced such loss can sympathize with other’s feelings, we must be attentive to the fact that they are mourning the loss of a relationship that was exclusively theirs. As Hospice volunteers, we must consider this exclusivity and abstain from persisting that the grieving person grieve any way other than what is best for

They were the subjects of public disputes with family members, court systems, medical professionals, the media, and society at large. Terri Schiavo, Nancy Cruzan and Karen Ann Quinlan; their names are synonymous with permanent vegetative state (PVS). The amazing technological advancements in modern medicine has been credited with keeping persons alive who in times past would have died, therefore this is remarkable for countless families. In the cases of the Quinlan’s, the Cruzan’s and many like them, families members find it unbearable to witness loved ones who linger indefinitely in PVS with little or no chance for recovery. There are many like Terri Schiavo’s parents, who value the lives of their love ones no matter how limited their

End of life care, is an approach that improves the quality of life of patients and their families facing the

The person in charge of the patient must decide between the wellbeing of the patient and following through with their wishes. When a patient’s wishes are being considered, their caretaker must also take into consideration their competence and self determination. Self determination, as stated by Jay Callahan, “must be based on at least four interrelated factors: free action, authenticity (or consistency), effective deliberation, and moral reflection”. When a patient is incapacitated or their judgement is clouded their right to self determination is removed. A lot of the responsibility for the decision being made falls on the guardian of the patient. These guardians may take advantage of the patient leading to their judgement changing. To outweigh this there must be strict procedure, such as the example set by the Netherlands. They must fit nine criteria which are as

The total number of people with a long-term condition in England is projected to be

In end-of-life scenarios, where the patient may not be able to communicate their wishes, decisions must be made either by the healthcare professional(s) or family member(s). However, who gets to decide or where the line should be drawn are not always clear. Consequently, not all decisions may be ethically permissible. To illustrate, I will discuss a scenario in which physicians and family are not in agreement. Upon proving a brief summary and explaining the ethical dilemma, I will provide moral reasons for two ethically permissible choices from which, by referencing the principle of autonomy and Utilitarianism, will determine which course of action ought to be carried out.

The phenomenon of death is a complex event wrought with controversy both medically and legally. Because the organ systems do not shut down all at once, it is difficult to determine the exact moment of death or the decide how the laws apply to the deceased individual. Although the advancement of medical knowledge and technology significantly decreases errors in when to call the time of death; it has also, paradoxically, increased ethical problems between families and doctors. Since the limitations of modern treatments are not well known to the public, families sometimes continue to demand intervention for recently deceased patients against physician recommendations or patient wishes. Moreover, the laws and hospital policies provide poor guidance for handling complaints, and thusly cannot adequately resolve disputes due to vast inconsistencies. To ensure the protection of patient and family wishes without overriding the physician's medical decisions, hospitals need to improve the funding, staffing, and organization of their ethics committees. By doing so, these committees can resolve disputes more effectively before they result in costly legal battles.

About 564,800 Americans are expected to die of cancer, which is the second leading cause of death in the United States, after heart disease and other terminal illnesses. There are laws that exist to protect the public when facing life situations like an abortion or executing a dead penalty. Advance health care directive is another document for the patients to express their health decisions. Americans should also be protected when a patient’s quality of life is poor, painful, and miserable from a chronic disease. They should be able to obtain the right to end their life with dignity. California recently approved the end of life option act that allows a patient to obtain a doctor’s prescribed lethal dose to finalize their life on earth.