...Being faced with our own mortality or that of a loved one, is a subject that’s very emotional, and some very difficult decisions will have to be made. But who should be making those decisions? The patient, families, the doctors? Should someone, who just received devastating news and is on an emotional roller coaster, make end of life decisions? How about the family members, who are so grief stricken and praying for a medical miracle, are wanting everything done no matter how bleak the outcome. What about the hospitals and doctors who know the cost associated with end of life care and realize that there is no real impact on curing or changing the outcome. They feel that resources should be spent on patients with better prognosis. In helping with some of these hard decisions the law makers in the state of Texas came up with the Texas Advance Directive Act. But the law has come under heavy criticism in recent years involving a few cases that received national attention. The Advance Directive Act passed into law in 1999 by then Gov. George W. Bush. With the passing of the act, Texas became the second state to pass regulation regarding end of life treatment.1 The law addresses and provides information on three different advance directives, the Directive to the Physician (living will), Medical Power of Attorney, and Out of Hospital DNR. A Directive to the Physician (living will), allows the patient to make their own wishes known about future medical treatments. Medical...
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...End of Life Nursing Donnie Barnes Oklahoma Wesleyan University End of Life Nursing Every life will end in death. It can happen anywhere or anytime along the human lifespan, but it will definitely happen. Death is never an event in life that is encouraged or hope for, however when faced with impending end of life circumstances, it can be faced with dignity and decency. Many people associate end-of-life care with treating physical pain and discomfort. While that is an important part, complete end-of-life (EOL) care also includes helping the dying person manage mental and emotional distress. An elder who is nearing the end of life who is alert might understandably feel depressed or anxious. Encourage conversations, so the elder has an opportunity to talk about their feelings. You might want to contact a counselor, possibly one familiar with end-of-life issues. If the depression or anxiety is severe, medicine might provide relief. A dying person might also have some specific fears and concerns. He or she may fear the unknown or worry about those left behind. Some people are afraid of being alone at the very end. This feeling can be made worse by the understandable reactions of family, friends, and even the medical team. For example, when family and friends do not know how to help or what to say, sometimes they stop visiting. Or, someone who is already beginning to grieve may withdraw. Doctors may become discouraged because they can't cure their patient and feel helpless...
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...End-of-life care becomes an issue at some point for elderly clients. Even with the emergence of palliative care programs and hospice programs, the majority of elderly people do not die in their own home as is their preference. What are the reasons for this trend? Discuss what you can do as a nurse to support your clients in end-of-life care and in supporting their desires. Support your response with evidence-based literature. Many palliative care patients would prefer to receive care, and to die, at home. Despite of this, many die in institutions. The need for the healthcare provider to discuss plans for discharge with most inpatients reinforces expectations of a choice of place of care. However, many palliative patients do not have a choice of care at home. A significant proportion of patients experience an emergency admission from home, after which it may not be possible to arrange discharge. Reasons for admission often reflect a change in the patient's condition, which may not necessitate inpatient care, but for which alternative arrangements cannot be made rapidly enough (Wheatley, et al, 2007). There are nearly 40 million senior citizens in the United States. But in the next 30 years, that number is expected to double to 80 million as Baby Boomers and their parents reach age 65 (CDC,nd). And each year, one-third of the people who die suffer from a chronic illness. For every one of these deaths, there is a patient and a family faced with difficult decisions about care...
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...THE CLINICAL, LEGAL, AND ETHICAL CONTEXT CHAPTER 4 DECISIONS AT LIFE'S END: EXISTING LAW page 49 New York law distinguishes between four types of practices that can arise at the end of a person's life: the withdrawal and withholding of life-sustaining treatment, whether based on the consent of patients or others close to them; suicide; assistance to commit suicide; and active euthanasia. The laws governing each of these practices reflect a judgment about the appropriate balance between individual autonomy and society's interest in preventing harm. At one end of the spectrum, the law covering treatment decisions embraces individual autonomy as its central concern, granting competent individuals a broad right to refuse medical treatment necessary to sustain their lives. Decisions about suicide and euthanasia fall at the other end of the continuum, where the law constrains individuals' actions for their own benefit and for the sake of the common good. Societal limits on suicide are reflected in laws that prohibit assisted suicide and euthanasia, regardless of the individual's consent. Likewise, while it is no longer illegal in New York State to commit suicide, there is no "right" to commit suicide as a matter of constitutional or common law. The Right to Decide About Treatment Under New York law, competent adults...
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...THE LAW ON ASSISTED SUICIDE On July 26, 1997, the U.S. Supreme Court unanimously upheld decisions in New York and Washington state that criminalized assisted suicide. These decisions overturned rulings in the 2nd and 9th Circuit Courts of Appeal which struck down state statutes banning physician-assisted suicide. Those courts had found that the statutes, which prohibited doctors from prescribing lethal medication to competent, terminally ill adults, violated the 14th Amendment. In striking the appellate decisions, the U.S. Supreme Court found that there was no constitutional "right to die," but left it to individual states to enact legislation permitting or prohibiting physician-assisted suicide. (The full text of these decisions, plus reports and commentary, can be found at the Washinton Post web site.) As of April 1999, physician-assisted suicide is illegal in all but a handful of states. Over thirty states have enacted statutes prohibiting assisted suicide, and of those that do not have statutes, a number of them arguably prohibit it through common law. In Michigan, Jack Kevorkian was initially charged with violating the state statute, in addition to first-degree murder and delivering a controlled substance without a license. The assisted suicide charge was dropped, however, and he was eventually convicted of second degree murder and delivering a controlled substance without a license. Only one state, Oregon, has legalized assisted suicide. The Oregon statute...
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...As people approach end of life care, they and their families are faced with difficult choices. During this time it is important to have a support system. In the case study Janelle decided against medical treatment and relied on her religious belief. Therefore it is necessary to use her personal strengths in interventions and to empower her when intervening. Her self-determination towards treatment should be respected, According to (NASW 2008), Social workers respect and promote the right of clients to self- determination and assist clients in their efforts to identify and clarify their goals. As social workers we will advocate Janelle’s position not to seek treatment to the other members of the interdisciplinary team; in doing so we will explore ways to decrease the tension between her and the other members. Janelle has a strong religious belief that she will be healed. As members of her interdisplinary team we will education her family on the pros and cons of relying on spirituality only for healing. We will communicate with Janelle by being open and honest in planning and assessing care for her and her family. Woodhouse (2011) suggested that effective communication has the potential to engender a therapeutic environment and relationship. Good communication skills are vital for spiritual carers in supporting patients, families, and the multidisciplinary team in dealing with issues such as denial and confusion. According to Amoah (2011), Spirituality is central to palliative...
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...End of Life Population Health Framework University of Massachusetts Medical School Fall, 2011 Articles 1. http://www.cancer.gov/cancertopics/factsheet/Support/end-of-life-care 2. http://www.loisgreenlearningcommunity.org/ < Compare and Contrast: The National Cancer Institute’s End of Life Care Questions and Answers on their website are written more the for caregiver or patient and describe what end of life care refers to. It’s formally written and describes each step or phase of care from initial diagnoses of end of life approaching or withdrawal of life saving measures such as chemotherapy to knowing when the patient has passed. It describes ways to take care of a patient at the end of life and when to call for professional help. It’s mainly geared toward the caregiver and really addresses all issues in providing care no matter how minor. The priority here is the well being and education of the non-professional care taker and the patient. The Lois Green Learning Community is an online resource for health professionals and a community to share experiences and also take care of yourself by doing so. It’s a place to blog or unwind about an experience, there are many resources listed for certification for palliative care and how to treat patients. It’s written with a very open and warm way and it’s a safe place to share your experiences, not formal and official like the NCI website. Communities like this are very important for health professionals to have a place...
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...End of Life Decisions Brandon Irving Grand Canyon University HLT322 10/25/09 Abstract With anything that is done in the medical field there will be ethical issues that surround it. Since we are only on this earth for so long then death becomes one of those issues that we must face. With the new advancements in technology death can become complicated. Also since we have other issues such as euthanasia involved things will only get even more complicated. Euthanasia, definition of death, living will decisions, and ethical issues surrounding these subjects will be discussed. End of Life Decisions No one living on this earth will live forever. It comes a point in time when we all must go. Our bodies are not made that way and they start to break down. Once deterioration happens or if a person comes into physical contact that causes the body too much trauma then death occurs. In the past twenty years four concepts of death have emerged, traditional, whole-brain, higher-brain, and personhood. Each one of these versions of death has ethical issues surrounding them and complicate important end of life decisions. Ethical issues surrounding when a person is dying is euthanasia and end of life decisions such has a person being on life support or having a feeding tube. Euthanasia is define as “The act or practice of killing or permitting the death of hopelessly sick or injured individuals (as persons or domestic animals) in a relatively painless way for reasons of mercy”...
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...End of Life Care Student’s Name Institution End of Life Care The cause for the trend of majority of elderly people not dying in their own homes as their preference is NHS failings, incorporating a scarcity of health visitors, which ensues in the desires of the elderly persons being ignored or not adhered to. Owing to poor co-ordination of social and health care services for the dying, the preferences of the individuals nearing death frequently go unidentified, and in instances where the preference to die at home is clearly stated, it frequently cannot be met (Rensbergen, Nawrot, Hecke, & Nemery, 2006). The social and healthcare providers conventionally offer low priority to end-of-life care as is evident in the lack of adequate training among significant staff. Another reason encompasses social-contextual elements. Gender, living status, and age are predictors of the location of death; however, the implant of a nursing home in a domestic community is the fundamental factor (Rensbergen, Nawrot, Hecke, & Nemery, 2006). As a nurse, to support clients in end-of-life care, and in reinforcing their preferences, one can come up with creative partnerships with healthcare professionals, patients, policy developers, and others to ascertain that care of the dying is prioritized. Moreover, one can record the comprehensive requirements of dying patients and families and taking note of individual, organizational, professional, and societal hindrances to quality end-of-life care...
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...would prefer to die at home, yet only about one-third of adults have an advance directive expressing their wishes for end-of-life care. Among those 60 and older, that number rises to about half of older adults completing a directive. The last 20 years have seen a significant shift in location of death from the community to hospitals and care homes. Those aged over 85 years account for the biggest rise in hospital and care-home deaths. Barriers to advance care planning include, • Lack of awareness: While advance directives are supported by state laws, there is still no clear process to allow an individual’s wishes to be known and ensure that care is tied to those documents. • Denial: A key part of the problem is our society’s denial of death and dying, and of being in a circumstance in which we are unable to make our own decisions and speak for ourselves • Confusion: Concern that emphasizing palliative and end-of-life care options could interfere with doing whatever it takes to help patients extend their lives as long as possible. • Cultural Differences: The majority of Medicare beneficiaries of all racial and ethnic groups say that in the event of a terminal illness with less than a year to live, they would want to die at home and would not want to receive life-prolonging drugs with uncomfortable side effects or mechanical ventilation to extend their life for a week or a month Among community-dwelling Medicare beneficiaries age 65 or older: • Blacks (18 percent) were...
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...Holland and participate in its physician- assisted suicide program. As your primary care doctor and oncologist for the past fifteen years I am very empathetic and very concerned not only with your physical health but your emotional health and experiences as well. Even though we have exhausted all therapeutic treatment options; I would really like for you consider hospice care here in the United States. Because I truly believe that hospice care can provide comfort and support to you, family, and friends. Hospice care is designed for those who are nearing the end of life. All care services are provided by a team of health care professionals who maximize comfort for a terminally ill patients by reducing pain and addressing physical, psychological, social and spiritual needs. To help families, hospice care also provides counseling, respite care and practical support. You are considering traveling to another country to end your life but if decide to stay here hospice gives you the option to receive this care in your home. In addition to hospice care for your consideration; the Federal Drug Administration has recently approved a new pain medication that wasn’t available before. This medication is was formulated and strictly marketed to treat pain associated with an illness' such as yours and of magnitude. The drug will be available in two weeks and it will be readily available. I have also investigated the probability of your insurance...
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...Peaceful End of Life Theory of C. Ruland and S. Moore I. Introduction a. Entire lives and careers are dedicated to postponing or avoiding death while caring for the living. Yet each day that passes, death is one day closer, unwavering. It is inevitable and unavoidable. Leaving loved ones behind creates sadness and shakes even the most stoic. Possibilities of pain evoke fear. Questioning faith, even the most devote become anxious when considering what has never been felt or seen. Ruland and Moore theorize that by easing the fears and anxieties, both real and/or perceived for the patient and family, nurses can create a more peaceful end of life, rather than simply complete the tasks at hand in the day to day when caring for the dying. II. Theory Perspective b. Defining “Peaceful” c. Dying is a personal experience and should never be alone. d. Five Outcome Indicators e. 16 Outcome Criteria III. Relationship to Nursing Practice f. Relevancy to Nursing i. Educate ii. Influence iii. Research g. Observe. Look, listen and feel h. Understand and Interpret i. Intervene with dignity, respect and empathy IV. Case Scenario V. Conclusion References Bjarnason, D. (2000, May). End-of-life care: Understanding and enhancing the nurse-patient dialogue. Retrieved May 3, 2011, from Proquest: http://proquest.umi.com/pqdweb?did=732206511&Fmt=2&clientId=14884&RQT=309&VName=PQD ...
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...Justin Sicheri 3/18/12 1 LOTF Poetry Project Poem excerpt | Insight | LOTF Excerpt | “The single clenched fist lifted and ready. Or the open asking hand out and waiting.Choose:For we meet by one or the other.” –“choose” by Carl Sandburg | In the same way that the poem “choose” is saying that the person must choose to be with or against but either way they will meet, So Jack on the island makes the boys choose between joining a tribe that is only concerned about being rescued and a fire or choose the tribe that is concerned about staying alive and hunting and protection. | “I’m going off by myself. He can catch his own pigs. Anyone who wants to hunt when I do can come too.” He blundered out of the triangle toward the drop to the white sand.” (127) | Poem excerpt | Insight | LOTF Excerpt | “From the thunder, and the storm- And the cloud that took the form(When the rest of heaven was blue) Of a demon in my view-“ “alone” Edgar Allan Poe | In the same way the poem says that when the rest of the heaven was blue, there was a demon in their view, so its saying that when everything else is okay there is danger right in front of you. In LOTF it shows the confrontation of the beast and the boys, so its saying that when they are stuck on the island with the beast everybody else around the world is doesn’t even know it’s happening. | “In front of them, only three or four yards away, was a rock-like hump where no rock should be. Ralph could hear a tiny chattering noise coming...
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...Examples of Reflective Writing Example 1 I arrived on the ward at 7:30 ready to begin a 12-hour shift. After receiving handover, my mentor assigned me the job of bathing Mr B with the help of a healthcare assistant. Mr B has Creutzfeldt-Jakob disease (CJD), a progressive disease of the nervous system with rapid deterioration due to spongiform encephalopathy. He is not expected to live to Christmas, even though he is only 19 years old. He is mentally aware of what is going on but is physically unable to demonstrate activities of daily living, including eating and drinking, has limited communication skills and is doubly incontinent. He is unsafe on his feet so mobilises with a wheelchair. I approached Mr B’s bed and asked his consent to take him for a bath. While the bath was running we began helping him to undress. He looked rather nervous. At the thought of myself being in his position, being the same age as him, I began to feel embarrassed too. I thought that I could not possibly be a professional individual if I let my embarrassment and sympathy get in the way of my nursing care. We assisted Mr B into the bath and started his wash. I knew he was uncomfortable and wanted to be able to wash himself, but was unable to do so. I was finding it difficult to look him in the eye, especially when it came to washing his genitalia. I tried to ease this by making conversation, but in a way this made matters worse. After the bath we dried Mr B, dressed him and returned him...
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...Cancer Pain: A Systematic Review and Quantitative Analysis of Research Publications in Palliative Care Journals by Senthil P. Kumar used descriptive methods of research to discover the number of research journals of the pain experienced in cancer patients toward the end of life. The research delved into the end-of-life care journals published from 19 facilities from 2009 – 2010 (Kumar, 2011). The study involved finding the percentage of research journals for end-of- life cancer patients’ pain in comparison to actual number of research findings. The data collection methods involved a search of Journals that had terms such as hospice, end-of-life, supportive, and palliative in the titles (Kumar, 2011). A total of 19 journals included in the study, which had a total of 2600 articles researched in the study. The studies uncovered articles concerning cancer pain, of which most were categorized into ‘original articles’ and ‘review articles’. Original articles were separated to studies of quality and also of quantity. Quantitative studies were grouped according to the study designs. Once the findings of the number of articles study designs were computed, the total number of journals pertaining to end-of-life pain of cancer patients was determined. Later categorization of articles were sort into groups such as those related mostly to cancer pain, articles with studies related to pain that mentioned cancer, and studies on cancer in which pain resulted (Kumar, 2011). ...
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