Terminal Illness and Patient Choice - Essay Example

Patient Choice and Terminal Illness Introduction When it comes to medical treatment and patient as well as patient choice, there are many factors to be considered. This becomes more serious in cases where the patient in suffering a terminal illness that has also reduced his or her quality of life significantly or has caused her what can be described as unbearable distress. Modern medicine recognizes the following factor which makes it more complicated with dealing with decision making, especially where terminal illness is concerned. These include; That health is interlinked with well being and therefore the patient should be given the right to choose the treatment (or no treatment t all). That the health and life/death of a patient is a great concern for the family and friends of the patient. That the doctor must be able to make the best decision that benefits the patient the most. In this regard, it would appear that there are at least three parties who are important in the decision making at such an end of life situation. These include the doctor, the patient and the patient’s family. The situation is even further complicated when the different members of the patient’s family don’t agree with regard to what is the best decision to make. This seems to be the case with Ella’s family where her decision with regard to how her treatment and end of life should be handled differs with her husband. Her family also seems to be in disagreement. Cultural and social issues With terminal illness comes the choice of death for the patient and sometimes the doctor. This comes with a number of social and cultural issues. Many cultures have not internalized the idea of doctor aided patient death for terminal patients. While the doctor may decide that it is better for the patient to stop her treatment and die with dignity, the patient and the family may ask that the patient continues with treatment until she dies a natural death (Wheatley and Baker, 2007). Even in cases where the patient may decide to have a physician-aided end of life, her family may not agree, especially due to cultural beliefs about death and life. In Ella’s case, this seems to be the case. Her husband of Indian decent does not seem to be very open with the idea of her stopping to take treatment and eventually ending her life. Medical issues There are various medical issues that arise in cases such as Ellas. First, the doctors must be able to understand that they have to take the wellbeing of the patient in a serious manner. It is necessary for the doctor involved in the situation to make sure that the best medical outcome is achieved. In a case where the patient is in a terminal condition, the doctor has to make sure that the patient is willing to go on with the treatment, it should be the patient’s choice that it most relevant (Garrett, 1993). Psychological and social issues The doctor has to face the difficult decision of having to tell the paint and those who care about her (family, friends) terminal conditions. Breaking the news about the terminality of a disease in a patient is something that is not easy. The doctor has to consider that the patient will suffer psychological distress. The family will also suffer the same and it is highly necessary for the physician to be considerate of this. Annotated Bibliography Kazdaglis, G. et al (2010). Disclosing the truth to terminal cancer patients: a discussion of ethical and cultural issues. Eastern Mediterranean Health Journal, 6, 4, pp.442-446. Kazdaglis, et al (2010) carried a study in the issue of palliative care with regard to terminal illnesses. In this study, they tackled the issue of breaking bad news about terminal illnesses to patients and their family. They found that the issue of telling the truth to terminal patients about the doctor’s diagnosis and prognosis is one of the issues that bring about the most ethical dilemmas. They carried a worldwide study to identity not only the trend of truth-telling in different culture, but also how different cultures regard the issue. Findings indicated that many, especially minority, cultures may not be open to the idea of the doctor informing a patient in terminal illness situation about their prognosis. Wheatley, V.J. & Baker, I.J.. (2007). “Please, I want to go home”: ethical issues raised when considering choice of place of care in palliative care. Postgraduate Medical Journal, 83, 984 , pp. 643–648. . Wheatley and Baker (2007) also carried out a research on the issue of patient choice with regard to terminal illness patients in palliative care. They established that a very high number of terminal illness patients always request to be taken care of at home. They also found that in most cases there are not resources to allow this with to be given to most patients and therefore most of them die in institutions, against their (patient’s) will. They found that there is a continuing effort among policy makers and professionals in trying to make patient choices of location of care and death more possible. Garrett, J. (1993). Life-sustaining treatments during terminal illnessLife-sustaining treatments during terminal illness. Journal of General Internal Medicine, 8, 7, , pp 361-368 . Garrett (1993) did a study to identify the factors that determine the way the patients choose to deal with terminal illnesses. He used a cohort of 2,536 patients and he found that an intricate set of demographic, educational, and cultural factors affect the way a patient may feel about the choice of treatment in case of terminal illness. This article is important to this study as it provides for the understanding of how various factors such as social and cultural factors affect the ethical issue of dealing with palliative care for terminal illness patients. McKinley, E.D. et al. (1996). Differences in end-of-life decision making among black and white ambulatory cancer patients. Journal of General Internal Medicine November , 11, 11, , pp 651-656 . McKinley et al (1996) did a study to investigate the differences between the black and white patients’ attitudes towards life sustaining medicine for palliative care patients. The study was intended to test the hypothesis that the reasons why these two groups differ with regard to the use of life-sustaining medicine is because the ethnic differences which make black people to have less confidence and trusts for the healthcare service. The study used 92 black and 114 white participants and the results indicated that the hypothesis tested wrong. This article is very useful to this study because it creates an even newer window of exploration into the factors which affect such decisions by the patients and their families. Kasman, D. (2004). Journal of Genenral Internal Medicine 19, 10. When Is Medical Treatment Futile?: A Guide for Students, Residents, and Physicians , PP. 1053–1056. Kasman (2004) carried out a research to investigate the decision making process with regard to how physician should decide when treatment for terminal illness is futile. The study is geared towards setting standards and creating a decision benchmark for inexperienced physicians on how to make such decisions. It also looks at the disagreements that may come up between the physician and the patient’s family. This is important because it brings in the issue of cultural issues as well as social and psychological issues to be considered. References Garrett, J. (1993). Life-sustaining treatments during terminal illness Life-sustaining treatments during terminal illness. Journal of General Internal Medicine, 8, 7, , pp 361-368 . Kasman, D. (2004). Journal of General Internal Medicine 19, 10. When Is Medical Treatment Futile?: A Guide for Students, Residents, and Physicians , PP. 1053–1056. Kazdaglis, G. et al (2010). Disclosing the truth to terminal cancer patients: a discussion of ethical and cultural issues. Eastern Mediterranean Health Journal, 6, 4 , pp.442-446. McKinley, E.D. et al. (1996). Differences in end-of-life decision making among black and white ambulatory cancer patients. Journal of General Internal Medicine November , 11, 11, , pp 651-656 . Wheatley, V.J. & Baker, I.J.. (2007). “Please, I want to go home”: ethical issues raised when considering choice of place of care in palliative care. Postgraduate Medical Journal, 83, 984 , pp. 643–648. . Read More