End of Life Decisions - Making the Right Choice - Research Paper Example

End of Life Decisions: Making the Right Choice for You Palliative care program is often associated with patients with a serious complex illness and it mainly focuses on relieving and minimizing the patients’ sufferings. During end of life, patients are offered palliative care by administering pain-relieving medication to ease the pain and suffering (Smith, 2012). The question of palliative care helps clients plan for alleviating pain and symptoms, help live life to the fullest and simultaneously have a voice in their care. This is done through the Rights to self-determination of treatment, medical experimentation during end of life, the ethics and effectiveness of continued routine medical interventions, allocation of resources and life support interventions. Patients’ rights to self-determination of treatment help them to participate in making key decisions about healthcare. Self-determination refers the right of competent individuals to decide about their health during medical treatment (Cersosimo, 2011). Medical experimentation during end life can sometimes be stopped especially when physicians realize that cannot be controlled anymore, but again the patient has all the right to refuse certain therapeutic or diagnosis to be performed on them. Furthermore, ethics and effectiveness of continued routine medical interventions play a significant role in enabling patients’ decisions about their medical care to be respected. The law and ethics allow patients to be the leading decision makers on their health condition and medical treatment. Lastly, allocation of scarce medical resources helps in determining therapeutic and diagnostic procedures to save the most individual lives. This paper explores the end life decisions with the first section covering the patients’ right to self-determination, followed by medical experimentation during end life, then ethics and effectiveness of continued routine medical interventions and lastly resource allocation and life support care. To begin with, patients’ right to self-determination of treatment is supported by the Patient Self-determination Act (PSDA) proposed in 1990 which allow patients to decide on their medical treatment as per their desire. This act gives patients the responsibility to make advance directives in order to declare their medical care and medical intervention they prefer (Pozgar, 2012). Notably, “advance directives in form of a living will and durable power of attorney” help patients to note the form of medical care they perceive as acceptable or unacceptable (Pozgar 2012). According to PSDA, patients particularly adult patients should have access to information about their rights to make decision and also about policies concerning advance health care directives once they have been admitted to the healthcare institution. This act states various rights accrued to patients such as the right to accept or refuse medical treatment, the right to lead or make their own health care decision, and also the right to make an advance health care directive. Furthermore, PSDA insists that facilities to educate their staff about advance health care directives and condemns the act of discriminately admitting or attending to patients on the basis of whether the patient has an advance health care directive. The aim of PSDA is to ensure that health care providers provide necessary information to patients concerning their right to decide about their medical care and to ensure that the patients are allowed to facilitate their future care. In addition, this act aims at preventing harsh treatment of elderly or disabled patients. Individual’s right to self-determination is part of human dignity and advance directives at the end of life influence individual’s important rights and values such as right to life and right to make own choices among others (Negri, 2012). Health care providers are recommended to make treatment decisions in line with the patients’ values, preferences and interests. More so, they are expected to respect the autonomy of the patient, for instance, they need an informed consent before undertaking any medical intervention and also allow the patients participation in decision making concerning their health condition. Patients’ autonomy helps them to control their lives as they wish and manage their relationship with health care providers (Negri, 2012). Through advance health care directives, patients who are able to understand the situation can declare their stand as to whether they receive medical treatment or not (Cersosimo, 2011). Togetherness of competent healthcare professionals, relatives and friends help patients to be aware and put their right to self-determination into practice. End of life care is actually that health care provided to patients in their final days of their lives or those patients with terminal illness. Medical experimentation during end of life is sometimes not acceptable, for instance, when health care providers realize that the disease cannot be controlled further, medical examination often stops but they continue caring for the patient to make them feel comfortable. Palliative care offered during end of life helps in controlling incurable diseases and enable patients to die in a way which is less traumatic (Smith, 2013). Medical experimentation during end life is done when the patient is in critical condition and should therefore be conducted carefully and effectively. During end life, some medical examination can be very stressful and undesirable to patients and so some medical intervention at this stage is not necessary and unacceptable especially for patients with terminal illness. Medical experimentation during end life may be done when the patient is unconscious and unable to refuse or accept this kind of medical intervention and this is against their right to self-determination. More so, based on the patient’s right to self-determination, the patient has the right not to accept some diagnostic or therapeutic treatment (Cersosimo, 2011). The ethics and effectiveness of continued routine medical interventions help patients’ decisions to be respected and this way, they are able to receive medical treatment desirable to them. It is both legally and ethically right for adult patients to fully participate as decision makers during their medical care. In cases where the patient is respected as the leading decision maker, they are protected from some medical practitioners who think they are making decisions that are in line with the patient’s interests. Medical practitioners are not allowed to perform tests and treatments on any patient without the patients’ consent. Therefore, medical tests or treatments done on patients without their knowledge are perceived as unlawful and unethical. More so, surgeons should ensure that patients are fully informed about the operation to allow them decide whether they want to have an operation or not (Lo, 2009). Unwanted treatment is not advisable in any health care facility because adult patients have the right to know what needs to be done in his body and so physicians providing any form of examination or treatment without the patient’s knowledge is committing assault. The patients’ right to either accept or refuse medical treatment and their rights to self-determination should be considered even if the patient’s decision is poorly formulated. Therefore, informed consent enables patients to make a meaningful decision concerning medical assessment and treatment. However, when patients refuse to undergo effective medical intervention, medical practitioners need to convince and persuade them to accept the treatment (Lo, 2009). In situations where competent patients cannot facilitate decision making process about their medical care, both ethics and law gives health care providers to treat such patients without their knowledge provided the treatment contributes greatly in saving their lives. Physicians are advised to seek consent for treatment from the patients’ relatives or close friends if necessary but if there is no one available, they can administer lifesaving treatment to save the patient. This form of emergency treatment is performed on those patients who cannot engage in decision making concerning their medical condition, but in case the patient regains consciousness, their decision should be respected. In most cases, this is done when the patients’ ability to make an informed independent decisions are compromised due to their condition. Allocation of resources helps to determine therapeutic and diagnostic procedures in recognition of human life. In most cases, patients who are in need of life sustaining treatments are allocated these resources not unless they decline such treatments or are found to be medically futile (White et al., 2009). Scarcity of medical interventions such as beds especially in intensive care unit, organs, and vaccines among others is a common challenge in health care. Indeed, allocation of such scarce medical intervention poses a major challenge to most medical practitioners and so making effective allocation decisions is necessary (Persad, Wertheimer and Emanuel, 2009). Making decisions about resource allocation is one of the major challenges that health care providers face. For instance, they are not allowed to offer any treatment and diagnostic without weighing their effectiveness. Moreover, they are not supposed to misguide interested individuals about the patient so as to cover or maximize reimbursement. Therefore, health care providers have the responsibility make use of available health-related resources in appropriate and efficient manner and avoid unnecessary and unethical activities. The decisions concerning resource allocation are effectively made at the policy level and ethical resource allocation policy is reached when individuals focus on the existing resources, how limited they are and then how to equitably distribute the available resources. Some of the resource “allocation principles are treating patients equally, favoring the worst-off, maximizing total benefits, and promoting and rewarding social usefulness” (Persad, Wertheimer and Emanuel 2009, p.423). Treating people equally involves providing patients equal opportunities with the scarce medical intervention like organ transplants, but favoring the worst off is guided by the principle of the sickest first whereby the transplantable organs and emergency-room care are given to those individuals in serious condition. The youngest are also given first priority during resource allocation. Maximizing total benefits emphasizes on saving the lives of many people and most life-years through prognosis strategy. The utilitarian rule of saving as many lives as possible is acceptable during emergencies in public health care facilities (White et al., 2009). Lastly promoting and rewarding social usefulness where social value allocation consider certain people in order to promote some essential values or rewarding individuals for promoting these values. Individuals are given priority to the scarce resources based on their value in the society and their contribution to the wellbeing of the society (Persad, Wertheimer and Emanuel, 2009). Life support interventions at the end of life determines clients plan of care for alleviating pain and symptoms, brings forth the rights to self-determination act which encourages everyone to decide now about the types and extent of medical care they want to accept or refuse, determines the effectiveness of routine medical procedures. Patient Self-determination Act ensures that patients’ rights to self-determination especially during decision making about their health care is communicated to them and protected accordingly. Advance health care directives presents in form of a living will of power of attorney enable patients to declare the form of medical care they view as acceptable or unacceptable. More so, advance directives help patients to declare whether they accept or refuse certain medical interventions. PSDA ensures that medical practitioners communicate necessary information regarding their right to make decision on their health care. Moreover, health care providers are expected to respect the patient’s autonomy and they need an informed consent before proceeding with any medical treatment or test. End life care is often offered to patients in their final days and those with terminal illness, and so medical experimentation at this stage can be stopped especially when medical practitioners realize that the disease cannot be managed further. Also during end life, the patient has the right to either accept or refuse certain diagnostic and therapeutic treatment. Accordingly, ethics and effectiveness of continued routine medical interventions helps patients to be administered medical treatment desired to them and their decision about their medical care is respected. It is acceptable by the law and ethics for adult patients to participate as decision makers during their medical care. Healthcare providers are prohibited to administer certain medical interventions on the patient without the patient’s knowledge, therefore, medical interventions performed on patients without considering their wish or consulting them is unlawful and unethical. In health care, scarcity of medical interventions is a common challenge. Allocation of scarce medical resources helps in determining therapeutic and diagnostic procedures to save the most individual lives. Medical interventions can be allocated based on certain principle like offering equal treatment, prioritizing the worst-off, saving many lives among others. This way, patients will be able to receive medical intervention they need. References Cersosimo, C. (2011). The Pre-Chosen Death: End Of Life Arrangements and Instructions. FrancoAngeli. Lo, B. (2009). Resolving ethical dilemmas: A guide for clinicians. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Negri, S. (2012). Self-Determination, Dignity and End-Of-Life Care: Regulating Advance Directives in International and Comparative Perspective. Leiden [u.a.]: Nijhoff. Persad, G., Wertheimer, A., and Emanuel, E. (2009). Principles for Allocation of Scarce Medical Interventions. The Lancet, Vol. 373, pp. 423-31. Pozgar, G. D. (2012). Legal and Ethical Issues for Health Professionals. Sudbury: Jones & Bartlett Learning. Smith, G. P. (2013). Palliative Care and End-of-Life Decisions. New York: Palgrave Macmillan. Smith, S. W. (2012). End-Of-Life Decisions in Medical Care: Principles and Policies for Regulating the Dying Process. Cambridge, UK: Cambridge University Press. White, D., Katz, M., Luce, J. and Lo, B. (2009).Who Should Receive Life Support During a Public Health Emergency? Using Ethical Principles to Improve Allocation Decisions. Annals of Internal Medicine. Vol. 150, pp.132-138. Read More