Patient Self Determination

A person’s life can end at any age. They can depart quickly or slowly. End of life care, also known as palliative care, is the care of patients that are not only in their final hours or days but the patients with a terminal illness that has become incurable. End of life care takes into mind what the patient desires so it is recommended that they consider an advanced care plan also known as an advance directive and living will. These documents allow the patient to formulate decisions on the future of their care if, at any point, they cannot vocally express themselves.

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.

Death is inevitable. It is one of the only certainties in life. Regardless, people are often uncomfortable discussing death. Nyatanga (2016) posits that the idea of no longer existing increases anxiety and emotional distress in relation to one’s mortality. Because of the difficulty in level of care for end-of-life patients, the patient and the family often need professional assistance for physical and emotional care. Many family caregivers are not professionally trained in medicine, and this is where hospice comes into play. Hospice aims to meet the holistic needs of both the patient and the patient’s family through treatment plans, education, and advocacy. There is a duality of care to the treatment provided by hospice staff in that they do not attempt to separate the patient’s care from the family’s care. Leming and Dickinson (2011) support that hospice, unlike other clinical fields, focuses on the patient and the family together instead of seeing the patient independent of the family. Many times in hospitals, the medical team focuses solely on the goal of returning the patient back to health in order for them to return to their normal lives. They do not take into account the psychological and spiritual components of the patient’s journey and the journey that the family must take as well. For treatment of the patient, Leming and Dickinson agree that hospice does not attempt to cure patients, and instead concentrates solely

.“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).

Key people could be family, doctors, carers, religious leaders etc. Each may own distinctive role to play in order for the choices and preferences of the individual to be respected and carried out. [ Every person’s end-of-life trajectory is different and needs differ in intensity and quality over time. End-of-life care must adapt to the varying and changing needs of the individual over time and that it cannot be limited to certain settings or services. The provision of good

Caring for patients at the end of life is a challenging task that requires not only the consideration of the individual as a whole but also an understanding of the

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.

A Death of One’s Own sheds light onto the controversial issue regarding end of life decisions, providing a few examples of people struggling with these choices. The film tells the stories of three particular individuals, Jim, Kitty, and Ricky, each with a unique end of life situation. Jim suffers from ALS and has specific care requests, 56-year-old Kitty struggles with her uterine cancer and constant pain, and Ricky is a patient dying from severe liver failure who can no longer speak and make decisions on his own. All of these individuals present different, yet similar issues regarding end of their life care. This film describes the importance of advance directives, the arguments surrounding physician assisted suicide, and this prompted me to form my own opinion on preparing my own directives and thoughts on these tough decisions.

The first aspect of this would be the patient’s physical pain and how they should have the right to die with dignity and in a humane way instead of suffering. It has been proven that end of life care is brutal and traumatic for many patients since they are forced to undergo long stretches of unnecessary treatments which only prolong their lives an extra month or two. But it’s not only the patients who agree that they

The Institute of Medicine defines a good death as one that allows patients, families and caregivers to avoid distress and suffering at a difficult time (Con & NET, 2007). What is considered a rational step in preparation for end of life in Western biomedicine, is seen as hindering to various ethnic minority groups, who are unable to exercise their beliefs (Frearson, Henderson, Raval, Daniels, Burke, & Koffman, 2013). Western medicine has expanded and taken predominance over medical practices worldwide. One of the key constituents of medical practice in Western societies, is the importance of ensuring patient autonomy. The implementation of the “Patient Self-Determination Act (PSDA)” in 1991, was a strategy employed to ensure that individuals were able to exercise their autonomy in making decisions regarding medical treatments (Doorenbos & Nies, 2003). The PSDA was instilled as a strategy to encourage healthcare professionals in educating their patients about the importance of advance directives (Doorenbos & Nies, 2003). The four main values carried by the PSDA revolve around the concepts of “autonomy over end of life care, informed decision making, truth telling, and control of dying process” (Giger et al., 2006, p.4). However, since its implementation, national statistics for completed advance directives amongst

With an increasing aging population and growing numbers of individuals with chronic conditions, it is important for individuals to prepare for end-of-life care. An Advance Directive is a defined as a “legal document that provides data to critical care staff about patients’ wishes, especially when critical illness decreases decision-making ability” (McAdam, Stotts, Padilla, and Puntillo, 2005). An Advance Directive also allows for better communication between the patient and doctor, and preserves the autonomy of patients. It may also alleviate one’s family from any possible burden of uncertainty of one’s wishes. It provides guidance, which may avert arguments with family members concerning treatment choices (Cedars Sinai, 2015). The Patient

End of life decision making and care are critical aspects of the delivery of patient centered healthcare. Advances in scientific knowledge and medical technology can now prolong the dying process indefinitely. Many Americans fear the possibility of dying a painful, protracted, or undignified death, in an institutional setting, absent personal control or meaning (Schwarz, 2004). With the modernizations of medical technology today, individuals are now given the option to choose how, when and where they die. This topic has prompted many ethical and legal debates regarding end of life care. As a result it has made it challenging for nurses and other healthcare professionals to provide appropriate care. Nurses need to incorporate the American Nurses Association (ANA) Code of Ethics and the professional standards of the Association of Hospice and Palliative Care Nurses when addressing end of life issues.

To force a patient to end his/her life is madness. This paper intends to focus on improving and developing the quality of care for the patient at his/her end of life. There are other medical treatments that are offered for the end of life care that will bring patient comfort. Clearly, hospice care consists of compassionate and excellence care for patients facing a life-limited illness or injury. Expert medical staff that gives emotional and spiritual support that is tailored to the patient and family needs and palliative medicine provided by a physician relieve patient’s suffering and improve the patient’s quality of life at any age or stage of the serious illness, when the illness is incurable, chronic, or

Health care issues and challenges affect every stage of our lives. From the moment we are born, nurses and physicians are available to welcome us into the world. When we think of a new life, we think of happiness and blessings from God. We celebrate life with baby showers and Christenings. Wellness checks and scheduled immunizations are implemented to prevent diseases, and promote healthy lifestyles. Unfortunately, end of life care and experiences isn't as joyous, or well planned by society. Death and dying is associated with pain, suffering and grieving, for both the dying person and their loved ones. The advancements in medical treatments and technology has improved health care, while increasing life expectancy. Life expectancy

The end of life may be months, weeks, days, or hours depending on the situation at hand. This should be a time when many procedures and treatments should be knowledgeable by the caregiver in charge of a dying patient. “Traditionally, a hospital’s goals have been to cure illness and prolong life; in contrast, hospice care emphasizes palliative care, which involves reducing pain and suffering and helping individuals die with dignity” (Albrecht & others, 2013; Holloway & others, 2014; Kelly & others, 2014) (p. 410) Palliative care focuses on relieving pain and meeting practical needs. However, this new type of care enables quality of life. Care providers will work to identify and carry out goals: symptom relief, counseling, comfort, and everything that enhances your quality of life.