EOLC Decisions

A physician must understand that when it comes to deciding to withhold or withdraw life sustaining treatment it is ultimately the patient’s decision unless the patient is not competent enough to make this choice. I believe that a person can lose their life at any point. Death is certain and no one can run from it. In my opinion, a patient’s autonomy is of utmost importance anytime during healthcare however the physician can name some recommendations of what would be the best option for the patient. When it comes to patients they deserve to be treated with respect and ultimately be treated as an end not as a means to an end.

Secondly, the patient should be capable of making and communicating health care decisions for him or herself. Thirdly, the patient must be diagnosed with a terminal illness that will lead to death within six months.  Interested patients must also provide the request for termination in writing to the physician. In addition, physicians are expected to inform patients to alternative means of care including hospice care and other medications. Only after precautions evaluation, the laws then permit patients to make the ultimate life ending decision.

A legal requirement of end of life care is that the wishes of the individual, including whether CPR should be attempted, as well as their wishes how they are cared for after death are

A patient barrier might include having limited knowledge surrounding life-support systems and treatment options, thereby hindering their ability to fully comprehend or demand certain interventions. Good counseling is therefore essential to overcoming this barrier in implementing the patient’s true and best wishes (Kroning, 2014, p. 222). Another barrier in implementing advance directives concerns the role and influence of family members and the patient. There may be discordance between the desires of the patient and family, which can result in serious debate and tension if not addressed and taken into consideration. Physicians still may have reservations, as certain demands made by the patient may raise ethical concerns in the future, if the provider feels the interventions being done are no longer medically appropriate.

The process of deciding when a terminally ill patient should die lies within the patient, family members, and the

The importance of end of life issues and decisions are now being discussed at the time of admission to most acute care and long term acute care facilities. More attention is being placed on these specific decisions to ensure that the patient's

It is very important that each individual, if possible has a say in his or her own dying and death. Facing death is hard for everyone and there are specific issues to be talked about in advance. A living will or a Physician Order for Life-Sustaining Treatment (POLST) is extremely useful. The POLST is designed for people with serious or life-threatening illnesses. “This is a standardized form that describes a patient’s wishes and is signed by his or her physician, providing both summary of an individual’s advance directive decision and the physician’s order. It can be used to inform emergency personnel about a patient’s wishes for life sustaining procedures, such as CPR. “

“An ethical dilemma exists when a choice has to be made in which the consequences may have a potential positive or negative outcome.”("Topic 4: Contemporary Ethical Dilemmas (How do managers evaluate beginning-of-life dilemmas?). ", n.d.) The given scenario presents a patient named Jamilah Shah, who is of Turkish descent, 90 years old and collapsed at the side of her bed in the extended care facility in which she resides. The patient suffers from Chronic Pulmonary disease and diabetes mellitus. The patient was rushed to the ER were the EKG and lab tests revealed she suffered a heart attack and she was started on anticoagulants. The patient has no advance directives and a communication barrier exists, the ER department contacts the emergency contact, one of the patient 's sons Bashir. The patient 's family arrives at the hospital and her son states that he makes the decisions and the wants a do not resuscitate order for his mother and no medical intervention other than comfort care. The social worker handling Jamilahs case is concerned by her family 's lack of support and that the family 's wishes are at odds with the patient 's request for help and her expressed desire to live. Furthermore if the patient does not receive a cardiac catheterization or is considered for a coronary bypass, she will surely die.

The current health situation should be explained in a non-technical way so the patient (if possible) family, and or valid surrogate can understand every aspect. The physician should also help them understand when there is no hope for recovery. Most often the organs are no longer functioning, or there is little to no brain activity; at this point suffering potentially outweighs the probability of recovery. Medical teams most often realize that the focus should be on comfort, rather than extending a dying life. This decision comes with a great deal of uncertainty, and will always be hard, no matter what age of the patient, or the circumstances. Kathryn Kosh, MD explains that, “Ready access to advanced modern technology has changed death from an event to a process… Defying death requires payment [in the form of] pain and discomfort or in an unacceptable decline in the quality of life.” Often times physicians will not prescribe treatment in the first place knowing that this option will not benefit the patient, prolong suffering; and will likely end in termination anyway. Therefore, allowing the nature of the illness or injury to take its own course of action. Another point of interest regarding this topic is that medical teams realize in most cases, that providing an ethical and dignified death can be just as rewarding as administering aggressive measures to save a

Not participating in the withdrawal of life-sustaining treatment means continuing unwanted treatment on the patient. Unwanted touching, regardless of intent, is considered battery and is illegal.

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.

With major advancement in medical treatments, it is now possible to keep a patient alive, which would not have been possible in former times. This has made end of life issue one of the most controversial issues in healthcare. Medical improvements have set the stage for ethical and legal controversies about not only the patient’s rights but also the family’s rights and the medical profession’s proper role. It is critical that any decision made in such situation is ethical and legal to preserve the rights of the patient and also protect the healthcare institution involved. It is very important when making decisions to discontinue treatments to make sure all other alternatives have been explored.

Our society finds it difficult to talk about dying and euphemisms are the norm. It is typical for both doctors and patients to be hesitant to initiate a discussion on dying. Focus instead is often more often placed on interventions and actions for managing symptoms. This avoidance can leave patients and their families unprepared for the inevitable death. (Schapira, 2010) It also often results in requests for therapies which may be excessive, costly and even painful in the hopes for a cure. One study demonstrates that when patients are aware that they are terminally ill, the majority are able to reach a state of peacefulness and also exhibit lower levels of distress. (Ray, Block, Friedlander, Zhang, Maciejewski & Prigerson, 2006) It is also important that family members are willing to discuss end-of-life options with their loved ones. According to elderly patients, they are most often the ones who initiate these conversations with their

Upon reflection of the Five Wishes, several thoughts came to mind. First and foremost, having a designated advanced directive is critical. There are countless examples of clinical experiences in with which families were overwhelmed with unexpected end-of-life decisions. As an educated caregiver, we should personally take the necessary steps to assure these tough decisions are known to someone who can facilitate the level of care desired. Such consideration of these elements of care in advance can help to support our loved ones during this emotional time. After review of the five wishes, I recognized that I would not want life-support measures if faced with irreversible deleterious outcomes that resulted from

Usually either patients or families have the legal rights to determine what medical course to take with the patient when it comes to the diagnosis of death, in this case the family's conflict needs be considered. The healthcare staff involved in the patient’s care must communicate with the family members during this difficult time. If the patient is determined to be dead, the family will need support from the health care staff that has been involved in the patients care, all available hospital resources, including medical, nursing, social work, ethics, and pastoral care will be a good resource for the family members. Lawyers will usually advise health care staff to work with the family in the most compassionate way possible, the lawyers should be there to help with any conflict between the family members, and this will also help the organization against any future malpractice suits against the health care staff and organization.