Low Acuity, Non-transport Decisions & Palliative Care, End-of-Life Decisions - Research Paper Example

? LOW ACUITY, NON-TRANSPORT DECISIONS & PALLIATIVE CARE, END-OF-LIFE DECISIONS SHORT ANSWER QUESTIONS You have a choice for this discussion You can choose to discuss a case that you have attended where palliative care or end-of-life decisions were involved (do not use any identifiable names or place details if you are writing about a case that you have attended) http://agooddeath.co.nz/ Important you need watch this video because, answer this question from this video. The following headings are suggested to structure your discussion. 1. Briefly summarise the key features of the case (200 words) 2 marks This particular case involves a 65-year-old man suffering from chronic obstructive pulmonary disease, a respiratory disease that has chronic bronchitis or emphysema as its features. The disease makes life quite difficult for the man as the disease makes him feel like 'fighting for breath'. The disease is severely debilitating and over time, the man deteriorates. In such a condition, the best he could get was the best palliative care possible in a hospice, but that does not provide answers to some nagging questions. One of the most important questions has to do with 'prolonging life or prolonging death.' The importance of such a question comes to light when one realises that the patient under review here is suffering from a chronic respiratory illness which eventually took his life. However, as medical personnel and other care givers struggled to provide him with the best palliative care, his symptoms were also inadvertently prolonged. That creates a conflict of purpose in the mind of the physician: Am I prolonging life or death? The case also gives a good demonstration of the dilemma that families face when they are to cope with the painful choice of having to take care of a patient suffering from a terminal disease such as COPD, cancer and similar ones (Taylor, 2011). 2. Identify and discuss at least two legal considerations in the case While taking a look at this case, there are several legal issues that surfaced, and the most important or crucial ones are: -The question of ending life In countries such as New Zealand where euthanasia is expressly illegal, this is indeed a very tough issue. Therefore, the case of the patient approving or even thinking of euthanasia or any medically-assisted suicide does not come into the picture. End of life is a very crucial stage in our existence and when it is now burdened with a perennial disease such as COPD, as seen in this case, it all assumes even a more radical dimension, legal matters included. The status of illegality that has been conferred on euthanasia in New Zealand means that all the patients and the family have to rely on is the palliative care, which does not always give the best to the patients. This is a very important issue and has thrown up even more controversies, which have been settled with legislations in countries such as the Netherlands (Dowbiggin, 2007, p. 149). -Who determines the degree and extent of the advanced care plan/palliative care provided? Although the Advanced Care Plan (ACP) makes provision for the patient to choose those to make decisions on his or her behalf when incapacitated, this also has the possibility of raising some legal dust. This is particularly true of a case where the patient is either a homeless, stateless or even an immigrant person who does not have a next of kin who can be easily tracked or called to fill in the gap. This is not always an easy question to answer (Taylor, 2011). (Provide reference to legal documents, guidelines or other articles/texts that discuss legal issues in regards to end-of-life decisions). 3. Identify and discuss at least two ethical considerations in the case As hinted in the section above, there are legal and ethical issues that arise from the case of end-of-life patients. Those that have the highest significance in bioethics are: a) How proper is extending pain or postponing death? In this case, physicians narrated of how some patients with respiratory illnesses felt: the advanced care that they were being given was only tantamount to prolonging their death and extending what can be regarded as their 'punishment'. This makes more sense when one realises that a lot of these diseases come with persistent pain as one of the most important features (Making choices, 2011). b) The concept of having a 'good death' Another issue that bioethics experts will find quite interesting is the idea of having a 'good death'. Physicians justify their palliative care, even if it means more pain, suffering or discomfort for the patient, based on the idea of getting as much of life and keeping death at bay for as long as possible – no matter the cost (Hinze, Iitis & Johnson, 2008; Taylor, 2011). c) Who decides in such a case? In a scenario where the patient is totally incapacitated and cannot even make any tangible decision, who decides the mode of treatment to be given? Even in an environment where medically-assisted suicide is allowed, who gives the approval or the go-ahead for such procedures? Even though this may look quite straightforward and an easy decision to make, the complexity of the matter becomes very apparent if one was to deal with a homeless individual with no trace of any family member as a patient. It even becomes more complicated when the patient remains unconscious and no valuable information can be sourced from the subject. Another thing that makes this decision quite controversial is that in a case where the care givers go ahead with a contentious mode of treatment, the family may later surface and question the rationale behind proceeding with such modes of treatment, especially if proper standards of ethics were not followed. It is also easy for authorities to be vested with the powers to decide but what happens when the patient is a foreigner or even an illegal immigrant? Should an illegal immigrant be placed on treatment for a chronic illness and funded with taxes of the citizens or simply deported back to his or her homeland? In this case, the stakeholders must find a balance between medical ethics, humanitarian activities and maintaining diplomatic ties between nations. (Provide reference to texts or articles that discuss ethical issues in regards to palliative care and end-of-life decisions) (400 words) 4 marks 4. Reflect on the case and how it was managed e.g. how did you feel about what occurred, was it managed well and why, how could it have been improved, was the communication between the paramedics and those involved adequate. If you are using the case provided consider how you would manage it and what would you consider important in your care of the patient and those involved. (300 words) 4 marks In my opinion, this case was well managed. The physicians, caregivers and the families all played their roles very well. It is quite unfortunate that even despite the best palliative care, the subject in question kept deteriorating. Communication between the paramedics and the family was superb, but I am of the opinion that a softer tone could have been used when explaining the severity of the illness to him. However, that must be done without blurring the reality on ground or underestimating the seriousness of the condition. If I am to manage this case, I will anchor my care and management on the following: a) Ensuring that the patient gets the very best palliative care possible. This was excellently done in this case, and I will strive to do something of the same standard or better, but definitely not less. b) Making sure that the patient does not end with negative thoughts. I need to emphasise this considering the fact that COPD has tobacco smoking as its greatest predisposing factor and there is every possibility at that stage for the sufferer to start having feelings of guilt or even worthlessness. This is particularly true in a situation where the person in question has been a chain smoker. So, it will be my duty to dispel such self-defeating thoughts, which can actually worsen the case if care is not taken. c) Communication, communication and more communication. In advanced care for individuals at the end-of-life stage, communication is of extreme importance, helping to lessen the impact of an otherwise debilitating condition, which happens to be a respiratory illness in this case. It is also important to point out or stress that communication is not only useful for patients in this category but for all classes of those in need of prophylactic palliative or non-palliative care. (Support your discussion with reference to palliative care material related to communication and the grief process) References Dowbiggin, I. (2007). A Concise history of euthanasia: life, death, god, and medicine. London: Rowman and Littlefield Publishers Inc. Hinze, B., Iitis, A. & Johnson, S. (2008). Legal perspectives in bioethics. New York: Routledge. Making choices: advance care plan for patients with chronic respiratory illness (2011). Southern District Health Board. Taylor, D. R. (2011). End of life care for patients with chronic disease – the need for a paradigm shift. Dunedin School of Medicine. Read More