Paternalistic Approach To Health Care

Caring for patients at the end of life is a challenging task that requires not only the consideration of the patient as a whole but also an understanding of the family, social, legal, economic, and institutional circumstances that surround patient care.

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

The beginning of life is celebrated. Books and resources are shared among friends and family in preparation for becoming a new parent. So, what happens as one approaches the end of life? Unfortunately, the same care and sharing rarely occurs in those circumstances and many face the prospect of dying unprepared. Though most people state they would prefer to die at home, this is often not where death occurs. Many Americans spend their last days attached to medical apparatus that keeps the body alive, but it does not allow for communication with family and often requires heavy sedation. Additionally, this level of treatment comes at a high price. As a society, we must become as comfortable in addressing the end of life process as we

Great strides have been made to improve end-of-life care through palliative care and hospice programs, but sometimes that’s just not enough. In America, the care that is offered to the elderly and the chronically ill is less than ideal. Statistics show that an

The cost and quality of health care and access to it is one of the foremost aspirations in national health care. And the overall main aims of reforming the American health care system is to reduce costs, enhance the quality of and access to health care [1].

Suffering at the end of life stems from multiple sources, including unyielding pain, depression, loss of personal identity, loss of control and dignity, fear of death, and/or fear of being a burden on others (AAHPM, 2007). The overwhelming symptoms lead many terminally ill patients to ask their doctors to help them die (Gorman, 2015). According to Dr. R. Sean Morrison, professor of geriatrics and palliative care medicine at Mt. Sinai’s Icahn School of Medicine in New York, “their choice shouldn’t be an assisted death or living with intractable suffering” (as cited in Gorman, 2015). The American Academy of Hospice and Palliative Medicine (AAHPM) (2007) strongly recommends that medical practitioners

The Institute of Medicine released a report in 1999 titled To Err is Human: Building a Safer Health Care System concerning the number of medical error related deaths. The report states that between 44,000 and 98,000 medical error related deaths occur each year in hospitals across the country (Kohn, L. T., Corrigan, J., & Donaldson, M. S., 2000) In response to this report, the Institute of Medicine released Crossing the Quality Chasm: Health: A New Health Care System for the 21st Century that outlines six aims for the future of the healthcare system: safe, effective, patient-centered, timely, efficient, equitable (Institute of Medicine, 2001). These aims set to establish the quality of healthcare across the country. Quality is defined by the Institute of Medicine as ““the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (2001).

When a terminally ill patient reaches the end of their life, many of them receive hospice care. Hospice can not guarantee how effective they will be in making that patient comfortable or how they will be able to function. The effectiveness varies from extremely effective care to very ineffective care. With such a wide range of effectiveness, patients begin to become concerned about how they will die. Many people find comfort in taking their own life before the drugs do (Sandburn 50). In Oregon, almost one hundred percent of the patients that requested the life-ending medication were receiving hospice care (Goodale, Grossman, and Grundy 16). Hospice was created with its main goal to comfort patients. Recent statistics show the real comfort has been found in the patient's right-to-die by physician assisted

There is a lot of fear surrounding death in American culture. Terminally ill patients fear that they will be in pain and agony as they are dying. They fear their loss of autonomy and being a burden to their families and to their caregivers. Research has shown that patients cite fear and loss of autonomy as the biggest motivators to request to terminate their lives, either through self-administered lethal prescription or euthanasia. These patients often do not have adequate information about hospice or palliative care (Pestinger, et al., 2015). Diane Coleman is the president of Not Dead Yet, a group that supports Americans with disabilities and opposes physician-assisted suicide. She states, “We need to respond to the desire to die with the message, ‘No, how can we help you? How can we be with you?’ That’s the real compassion people deserve” (Ross, 2015).

Dr. Ira Byock’s latest book, The Best Care Possible: A Physician’s Quest to transform Care Through the End of Life, is a remarkable book written from a personal perspective as one of the foremost palliative-care physicians in the country. Dr. Byock shares stories of his experience with patients in his clinical experience to illustrate how end-of-life care affects each person. He explains what palliative care really is and how to make humane choices in a world obsessed with conquering death. Byock presents an agenda for end-of-life care that stresses compassion, dignity, and each patient being viewed as a unique case with the opportunity to partake in shared decisions amongst a team of professionals and family members. Dr. Byock is an advocate of dying well in a society marked by a fear of death; his highly personal account provides thought-provoking vignettes of how people struggle to make the right decisions in the winter of their lives. Byock urges society to embrace the reality of death and transform the medical community into an environment that will allow patients to live the last of their days in comfort with dignity and peace. This book is a vitally important piece of literature for everyone to devour with fervor. Everyone needs to understand the inevitability of death and the environment end-of-life care can present in what will be the final moments of life.

There are occasions when medicine is not your friend and the effects of the treatment will only prolong the suffering of the patient. Healthcare professionals must be objective and ask will the end result be changed. We must know when it is appropriate to discuss end of life options and when it is not. According to Adams (2015), most desire to die at home, but less than half are allowed to do so (p. 13). Our responsibility is to allow the client to make an educated decision about all the available service and treatments.

Physician-assisted suicide enables terminally ill patients to die comfortably and peacefully in their own homes. Terminally ill patients suffer through constant pain in their final months, and there remains a “residual obligation to relieve suffering” when palliative and hospice care reach a stagnant point (Quill). Patients will reach a point where the value of life weighs against the consistent suffering they endure on daily basis. Those seeking physician assisted suicide maintain the ability to forcibly starve themselves by declining food and drink. It takes more energy for terminally ill patients to push themselves to

One healthcare trend that needs to be changed is the cost savings vs. quality care that we see more and more with Medicare and other insurance companies. Coverage is denied to people who really need care. After years of attention to cost-cutting in all aspects of healthcare, I believe it is time to focus more on the quality of patient care.

First off what is value in healthcare? It is achieving high value for patients must become the overarching goal of health care. This goal is what matters for patients and unites the interests of everyone in the system. The customers do not buy a product. They buy the value and utility that you put into your product. Just like patients and their doctors. The patient’s insurance pays for the doctor’s visit. Instead of being paid by the number of visits and tests they order, providers’ payments are now based on the value of care they deliver.

The first is an attitude referred to as ‘paternalism’. Almost all governments around the world bear the wide spread idea that consumers should not be left to suffer the consequences of poor investment decisions in health. Governments, national and international health bodies through policies proscribe health-risking behaviors such as banning recreational drugs, placing quarantines during outbreaks, and enforcing immunization. In this context, it is assumed that the policy makers know best what is good for the individual e.g. the individual does not know the importance of vaccination and therefore must be protected from their ignorance of poor