End Of Life Decisions: A Case Study

The purpose of this paper is to examine communication strategies related to palliative and end-of-life care with a focus on Aboriginal clients. Firstly, I will explain the role of cultural competence in the nursing care of an Aboriginal client. Secondly, I will argue the cultural challenges a nurse may face when caring and communicating with Aboriginal clients receiving palliative end-of-life care. Thirdly, I will present solutions to the aforementioned communicative challenges. Lastly, I will discuss the impact I believe this experience may have on my future practice.

.“As medical technology continues to advance and health care choices become more complicated, the preservation of end-of-life autonomy is an increasingly important issue faced by various client populations.” (Galambos, 1998).

In today's society, one of the most controversial issues is physician-assisted suicide for the terminally ill. Many people feel that it is wrong for people, regardless of their health condition, to ask their health care provider to end their life; while others feel it is their right to be able to choose how and when they die. When a physician is asked to help a patient into death, they have many responsibilities that come along with that single question. Among those responsibilities are: providing valid information as to the terminal illness the patient is suffering, educating the patient as to what their final options may be, making the decision of whether or not to help the patient into death, and also if they do decide to help,

In reviewing the two studies I found, it is very clear there is a difference in quantitative and qualitative studies. To start, Lee et al. (2017) conducted a qualitative study in which the problem statement recognizes that end of life care (EOLC) in dementia patients is less than optimal when compared to cancer patients. The researchers aimed to determine what service managers and frontline staff at different facilities felt were the key aspects in improving EOLC in dementia patients (Lee et al., 2017). As a result, the researchers purpose was to contribute to the current evidence base on good EOLC and interventions to increase quality of care of end of life dementia patients.

Since all diseases are not curable, a lot of people are living in severe pain that is unbearable. Assisted suicide, also known as mercy killing, is the act of bringing the death of a hopelessly ill and suffering person in a relatively quick and painless way. Indeed, it is one of the effective solutions for people who are suffering in pain from terminal illness and especially for children who are not able to choose for their own lives. Even though assisted suicide is not legalized globally, there are few countries and six states in America including Washington State that allow such action. Many people are still against an assisted suicide system. However, since America is the country of freedom, people should have choices

Physicians assisting in suicide deaths are not productive in this area because some not trained in this field of expertise. Moll assert, doctors, are of little help. They have no training in how to discuss end-of-life issues with families and patients, so they avoid the conversation and call on other staff trained in this area. (88) Moll also points out, "people wants to be cared for, even if they do not want every possible procedure performed on them." (88) The best thing for people to do is discuss their end-of-life arrangements before major decision making is needed so the doctors, hospital staff and family members would not have to deal with the stress of this situation.

In California, the End of Life Option Act, is the law that permits adults who are terminally and also have the to capacity to make medical decisions, to be prescribed medication that aids in their death after meeting certain conditions (End of Life Option Act, 2017).In order to meet the conditions for this prescription, individuals must be at least 18 years of age, reside in the state of California, received a diagnosis that their disease is irreversible and are expected to have only six months left to live, are able to make medical decisions for themselves, be able to voluntarily request the prescription, and be able to self-administer the aid-in-dying medication by eating, drinking, or swallowing it (End of Life Option Act, 2017).

Seldom do they work with an individual who is planning to end their life and not intervene. It is important for MHPs to set aside their personal beliefs and focus their efforts into the clients’ well-being (Kaplan, 2008). It is essential to remain ethical while practicing. Ethical guidelines can be interpreted in a number of ways. “Minimiz[ing] harm where it is foreseeable” must take into account the client and their unique situations (Kiser, 1996). If a client has decided to end their life by assisted suicide, they have already taken multiple steps and been declared competent by physicians. If a client requests the MHPs attendance at their assisted suicide, the MHP should attend and provide support, but know that it is imperative to never handle the medication. The client must always self-administer the medication under the Death with Dignity Act. The National Association of Social Workers allows “client self-determination if clients are competent to make their own choices and are not being coerced” (Kaplan). For a MHP, the responsibility to stay educated on the progression of assisted suicide must be owned. Continuing personal education and developing a network with other MHPs with knowledge of the issue, can provide more insight and assistance for your

The criteria that must be met are stated in the End of Life Option Act The patient must be a resident, have been diagnosed with a terminal illness, 6 months or less to die and must be legally an adult. In the United States an adult is considered someone that is 18 years of age or older. According to California’s state law AB-15 End of Life Action Act, a patient must meet all of the criteria before the physician is able to administer the medication to end the patient’s suffering. These laws were passed under different circumstances but one of the main ones was the cases that kept arising in different parts of the country where patients were requesting to end their lives.

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

Is the role of a medical professional to ensure the health and comfort of their patients, or to help them end their lives? Since Dr. Kevorkian assisted in the suicide of Janet Adkins in 1990, physician-assisted suicide (PAS) has been one of the most controversial issues in the medical field today. While some view it as an individual right, others view it as an unethical issue that goes against medical ethics and religious values. Mr. H. M. is an elderly man who is diagnosed with terminal lung cancer and no chance of improvement. After excruciating pain and suffering, he has decided to request physician-assisted death in his home state of Oregon. Oregon’s Death with Dignity Act (DDA) states that terminally ill patients are allowed to use

Ethical dilemma may also arise in cases where a patient may feel their right to DNR should be carried out when giving direct order. The DNR process, however, is required to be documented by a physician. Andrew Putnam (2003) presents a case where an eighty-eight year old patient’s code status was DNR; “However, the patient has never signed formal advance directive statement or assigned durable power of attorney for her health care to anyone.” (Putnam, 2003, 2025) Ethics can be simply stated as doing the right thing (Roberts, 2002, 242); but in this case ethics is questioned because the physician was faced with the decision to carry out the wishes of the patient or to make a decision based on legality. In this case, it may have been morally right to carry out the wishes of the patient who wanted DNR orders carried out, but it may have been the right choice to do the legal thing and not carried out due to lack of signed documentation.

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.

The principle of autonomy states; “individuals have the right to make choices about their own lives” (Kozier et al, 2010.p.79). In health care, this means health care providers must honour the person’s right to choose methods or approaches to diagnosis or treatment (Kozier et al, 2010). Moreover, by not giving the client, the right to make her own decision this could cause anxiety and physiological effect to both parties. Which disregard the World Health Organization (WHO), definition of quality end of life care as the "active total care of patients whose disease is not responsive to curative treatment" (Sepúlveda, Marlin, Yoshida, & Ullrich, 2002). This definition includes meeting the psychological, social, and spiritual needs for both patients and families (Sepúlveda et al, 2002). In addition, the nurse did not put the beneficence principle in action, which “is the obligation to do good” (Kozier et al, 2010, p.80). Nurses have a duty to implement actions that benefit their client’s best interest (Kozier et al, 2010). It lays the groundwork for trust that society places in nursing professional, and provides nursing’s context and justification (Burkhardt & Nathaniel, 2002). This principle seems straight forward, but it is actually very complex. Should we determine what is good- by subjective, or by objective, means? So, when people disagree about what is good, whose opinion counts? In this case, the client, and not the family because she has the