HSC 3048: Support Individuals at the End of Life

•The modern focus on disease and the time and other pressures many physicians are under means that sometimes the patient can feel like they are on a treatment treadmill and not being listened to.

According to Kubler-Ross’s theory, the first cycle is denial. Denial in this case is the individual denying that they are dying. When the individual resists the reality that they are going to die. “Then where shall I be when I am no more?

.“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).

Understand the requirements of legislation and agreed ways of working to protect the rights of individuals at end of life;

There are agreed ways of working and legal requirements in place that are designed to protect the rights of an individual during end of life care, these are as follows:

Sometimes the person returns to a previous stage. Death is emotional and it is natural to experience emotions. It would also have a psychological affect on an individual as knowing you’re going to die may be frightening.

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. “

legislation to acknowledge a human beings fundamental right to make their end of life decision,

This film explains the legal role of advance directives in end of life issues. An advance directive is “a written document directing how medical decisions are to be made in the future when the patient lacks decisional capacity and is unable to decide and choose” (Hanlon, End of Life Issues, Slide 28, Bullet 1). All three of the cases demonstrate the importance in filling out some form of directive. When there is nothing to go off of, it makes decisions extremely tough for families and medical providers. Having legal documentation of patient wishes helps understand what treatments they would or would not consent to. In cases like

Autonomy explores the idea of every person having rights in regards to healthcare and decision making. “Autonomy is an agreement to respect another’s right to self-determine a course of action and support independent decision making” (Beauchamp & Childress, 2009). In 1990, the ideas of autonomy lead to the Patient Self Determination Act which allows competent people to make their wishes known about end of life. The act includes living wills and health care power of attorneys, which deals with end of

Elisabeth Kubler Ross was a psychiatrist and revolutionizes how people view death and dying. She would listen to dying patients a give them a public form. She came up with five stages of grief. They stages are denial, anger, bargaining, depression, and acceptance. These stages are used universally.

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 article on businessballs.com discusses the Kubler-Ross model for death and dying. The main argument that I take of this is that it is only a model, and not solid steps that one will go through when facing death or other challenges. The steps are denial, anger, bargaining, depression and acceptance. Some may go directly to the acceptance stage, however others may stay in the denial stage for an extended period without actively trying to move on. Dying does not only affect those who are personally spending but also those who are surrounded by it, spouses, children, caregivers, friends, and other family members. The stages can describe someone dying or those around them.

Although most people hope to die quickly and without warning and in their sleep; in reality for people experience a death that is: lingering, draw out and with plenty of forewarning, most likely of a chronic illness.

One of the chief arguments supporting legalization of euthanasia, is that built upon the concepts of individual "free will, autonomy" and the right to exercise them. However, the elevation of these rights of the individual above those of the greater social group are a concern. The concern which arises, is that institutions which would exercise the free will of an individual, on a populace of individuals who are terminally ill, might lose track of the elusive quality of freedom as it relates to will, and implement someone else 's will upon an unwilling individual, or upon an entire group for that matter.