Making the Right Choices: At the End of Life - Research Paper Example

? MAKING THE RIGHT CHOICES: AT THE END OF LIFE Life is full of openings and every individual has the option of making a choice. Every choice has its consequences good or bad. We all live due to the decisions we make each and every day. The people who are successful in this world are those who make good choices. Hence, it is essential for each individual to come up with the right end of life decisions. The technological advancements have seen arise in more and better healthcare services. Diseases which could not be treated in the past can now be curable or controlled. The use of palliative care is one method of ensuring that a person receives better healthcare during his last days of life. Individuals have options of using advance care planning or life sustaining treatments when making decisions regarding the kind of care they need at the end of life. Outline Thesis statement: It is a fact that all of us face an imminent death at any time. While still healthy it is thus essential for us to strategize on matters concerning health care. In light of these facts the thesis is based on the need to make the right decisions concerning end of life care. Introduction. What does end of life care entail The essence of end of life decisions The involvement of physicians and medical practitioners in the decision making regarding end of life care. Use of advance care planning method to ensure that right decisions are made according to an individual’s preferences. The process of shared decision making and its benefits Life support mechanisms Cultural influences on an individual’s decision making process. The withholding or withdrawing of certain medical treatments. Conclusion. Making right decisions All of us someday will end up dead. The recent days have shown a trend of an increase of non-sudden deaths which are a result of diseases like cancer and cardiovascular complications; these have replaced the acute deaths caused by infectious diseases. However, the ever increasing technological advancements in the health care sector has raised the life expectancy and also, provided the necessary technology to enable the prolongation of the life of very sick patients. With all these inventions there is need to come up with the right decisions concerning end of life care. The term palliative care according to WHO refers to mechanisms which provide better care to patients who are severely ill and ensures sufficient support to them and their families, by alleviating pain and suffering through early detection and planned strategies. This approach of palliative care is the best fronted method of caring for terminally ill patients (WHO, 2011). End of life care is a branch of palliative care method which intends to ensure that a person and his family plan well for his last days on earth. In the recent past, more innovations and inventions in the medical field have ensured mechanisms that can reduce patients’ pain and suffering being developed through better healthcare systems and facilities. Making the right decisions about the end of life is an essential part of end of life care which has a momentous effect in the dying process and the last days of the patient to be of peaceful nature. Moreover, death is often preceded by decisions of end of life regarding medical aspects that possibly to a certain degree of life-shortening effect (Raijmakers, et al. 2010). Through the various researches made in the recent past the following are the main categories of end of life decisions made include: 1) Euthanasia; the process whereby a patient requests to die quickly by being given certain drugs which hastens death. 2) Physician assisted suicides; the processes of prescribing specific drugs with the absolute aim of enabling the patients’ terminate their life. 3) End of life devoid of an unequivocal request from the patient; process whereby the doctor gives the patient certain drugs to hasten death with no clear request from the patient. 4) Mitigation of pain and symptoms; this is done through the administering of high or strong drug dosages that can possibly hasten death or cause death as a side effect. 5) Withdraw or withhold a treatment which could prolong a patient’s life. Other than this five key end of life decisions some people also consider the place to die to be an imperative end of life decision (Raijmakers N., 2010). Despite the role and obligation health practitioners have to their patients they also have to carry their duties with due diligence and observe the various ethical and legal values. These principles include: 1) Beneficence; this are acts that stimulates growth or considers the needs and wants of others, and in addition, the solemnly goal of any health practitioner is to make decisions on the basis of what a patient needs and not his own values. 2) Honesty; it is the responsibility of health care practitioners to always tell the truth to patients whatever the situation at hand. 3) Non-malfeasance; that is a person should not inflict or cause harm to others, hence always do good to others. The healthcare provider has the responsibility of not harming his patients. 4) Valuing the patient’s independence; that is a patient has the right of self-sufficiency, implying that the person is free to accept or reject certain treatments as he deems fit. 5) Justice; the act of not being prejudiced when caring for patients, particularly if the resources offered are inadequate. 6) Dignity (Lampert, et al. 2010). Hence, from these principles the patient has a lawful and ethical right to stop receiving any medical care administered to him. Also, the legally assigned individual to make decisions when he is not able has the same rights. Furthermore, every adult is liable to his actions, decisions and their implications. Advanced care planning: Some of the key essential issues that should be addressed when an individual nears the end of his life are the kind of preferred treatments to receive. This includes options like being resuscitated incase his heart stops or be given certain antibiotics in case of an infection. People generally have a duty to outsource information regarding better health care practices and strategize for current and future medical care. However, for example, people suffering from diseases such as dementia may die earlier and at some point due to their illness might not be able to communicate their medical care preferences. This brings up the importance of advanced care planning strategy (Froggatt, et al. 2009). Advanced care planning is the self involvement in the consultation of best medical care that can be applied with people close to an individual and health practitioners. Then the individual is free to develop personal and informed decisions based on the knowledge gathered. This can be documented to be used when the person is not able to communicate his/her own wishes. The aim of this process is to ensure that the necessary care is offered according to the person’s wishes and not done according to the medical practitioners assumptions on what he deems fit. Three main issues included in advanced care plans include: 1) advance declarations to relay an individual preferred choices, 2) advance decisions to refute certain treatments, this are applied if they are legal and depending on the situation at hand, and 3) the delegation of health care power of attorney to someone; will have say on health matters on behalf of the patient (Froggatt, et al. 2009). The surrogate decision makers always have or face difficulties in decision making when they don’t know what type of treatment the patient would have preferred. They become unsure on the patient’s prognosis, and restless in the care situation. Faced with slow or poor communication, may encounter conflicts with the health care providers or internal family feuds. They have inadequate time to develop informed decisions, experience thoughts of lone accountability and feeling of guilt about the decisions they make. The presence of the advance care plans may reduce some of these stressors (Black, et al. 2009). The shared decision making: Shared decision making is an essential step to ensure informed decisions are arrived at. In the patient driven decision making process the physician avails the options present and the patient makes his/her own choices. The physician doesn’t give any recommendations but only gives expert knowledge. The physician-driven decision model allows him to give the various choices available and provide recommendations. It is essential for the physicians to take into account the patients values in their recommendations rather their own. This model requires time and good communication skills on the part of the physician. On bearing in mind the patient’s needs the physician should guarantee that the patient is not deliberately or inadvertently coercive (Kon, 2010). In equal partners’ decision building, a consensus between the patient and physician is arrived at. This model needs both parties to first develop a good relationship and be able to know the principles and prejudices of the other. Shared reverence and appreciativeness are vital. Since the patient and physicians have varying views, thus it is the duty of the physician to ensure his perception doesn’t determine the decisions to be made. Thus the physician will come up with the best options to be carried out. Also it is essential for patients to recognize that they have the power of not bluntly agreeing to whatever the physician says and their views are highly accepted (Kon, 2010). Life Support: During the last few moments of a terminally ill patient is close to dying, the life-supporting mechanisms are not used since they seem to extend the dying process. Despite that, those patients with short life expectancies are not routinely barred from the intensive care unit (ICU). If the life sustaining treatment may have beneficial aspects to the patient, ICU admission may be considered however, the perils and distress should be elucidated. A lot of people have little or completely lack the knowledge on what an ICU can do and who should go to an ICU. The misconceptions are mostly influenced through the watching of the current TV shows that show the power of ICU to restore health which feature resuscitation nothing short of miraculous (Back, et al. 2009). Religious/Cultural beliefs and DNR Orders: The belief that life is precious and should be sustained at any cost is strongly held by some people. Physicians have no business on determining which belief is the best and should be followed. Their duty is to offer advice and recommendations. They should clarify the process of resuscitation, the involved risks, potentiality of being successful, and reality that Cardiopulmonary Resuscitation (CPR) may deteriorate the patient’s general health. Patients are allowed to consult with family members and friends before making decisions if to undergo CPR. Do Not Resuscitate (DNR) orders doesn’t necessarily mean that the patient has lost hope and also should the medical team do so (Back, et al. 2009). Withholding or Withdrawing treatments: At the end of life any medical intervention offered to the patient may deem not beneficial to prolong his life. These interventions can be use of antibiotics, artificial nutrition, hydration and life support. Thus the patient and the health care providers can agree to withhold or withdraw these medical treatments. This practice doesn’t mean to speed up death like euthanasia but it is a legally and ethically accepted method. Many physicians are indisposed of withdrawing a certain treatment due to the fear that it may be termed as euthanasia or physician-assisted suicide. Two major points contest this apprehension: 1) the intention of the physician, and 2) the real reason the patients’ died. In withdrawing a treatment which is not wanted the purpose is not to hurt the patient, rather it is to eliminate an unnecessary intercession that the patient sees as intrusion (Kapa, et al. 2010). Conclusion: Physicians need to develop basic decision making and implementation skills regarding life support treatments. Every case is different and there is no one overall decision which can fit all the situations. Hence, each medical case should be treated on its own. The main factor needed for successful decision is communication. Every individual has a right to make his/her own decisions regarding health issues. People who want to ensure they have a better end of life care plan usually strategize about their present and future care needs. These are achieved through use of advance care plan methods and through thorough discussions with family, friends and their physicians. People need to be well informed on the kind of life sustaining treatment to take before making any decision to use them. The advance directives should be able to state clearly an individual’s personal wishes. References Back, A.L., Young, J.P., McCowan, E., Reinke, L., et al. (2009). Abandonment at the end of life from patient, caregiver nurse and physician perspectives. Arch Int Med. , 169 (5), 474-9. Black, B.S., Forgaty, L.A., Phillips, H. & Rabins, P.V. (2009). Surrogate decision makers; understanding of dementia patients, prior wishes for end of life care. Journal of Aging and Health , 21 (4), 627-650. Froggatt, K., Vaughan, S., Benard. C. & Wild, D. (2009). Advance Care Planning in Care Homes for Older People: An English Perspective. Palliative Medicine , 2 (4), 332-338. Kapa, S., Mueller, P., Hayes, D. & Assirvatham, S. (2010). Perspectives in withdrawing pacemaker therapies at the end of life: results of a survey of medical legal professionals and patients. Mayo Clin Proc. , 85 (11), 981-90. Kon, A.A. (2010). The Shared Decision-Making Continuum. Journal of American Medical Association , 304 (10), 903-904. Lampert, R., Hayes, D., Annas, G., et al. (2010). HRS EXpert Consensus Statement on the Management of Cardiovascular Implantable Electronic Devices (CIEDS) in patients nearing end of life or requesting withdrawal of therapy. Heart Rhythm. , 7, 1008-26. Raijmakers, N., Van der Heide, A. & Van Zuylen, C. (2010). International Multidisplinary Consensus on Important end of life Decisions. European Journal of Oncology Nursing , 14, S6-S7. WHO. (2011). WHO definition of palliative care. Retrieved February 15, 2012, from World Health Organisation: http://www.who.int/cancer/palliative/definition/en/ Read More