End of Life Issues - Term Paper Example

 End of life Issues Abstract Physicians who treat patients approaching the end of life often face moral, ethical, and legal issues involving shared decision making, futility, the right to refuse medical treatment. A better understanding of these issues and an awareness of the availability of effective palliative care will help physicians, patients, and families adequately address the end-of-life issues. This paper briefly analyzes the end of life issues such as advance directives: living will, durable power of attorney, and DNR. It also addresses ethical issues such as life sustaining treatment. Introduction Death is the most worrying factor as far as human generation is concerned because of the uncertainty after death. A person who nears the end of his life will often lead a stressful life since he doesn’t have much idea about what is going to happen at the next moment or thereafter. Though religion has offered him an eternal life after the death, because of the uncertainty in achieving it, even the preachers of religion will under immense stress when they approaches the end of their mission on earth. Doctors especially the physician who treats such aged persons will often come across with confusing situations. They may be forced to violate the codes of medical ethics for the sake of the patient’s well being. Effective advance care planning is important in providing good care at the end of life because it enhances a discussion of end-of-life issues between the patient, physician, and caregivers. The end of life issues such as advance directives: living will, durable power of attorney, and DNR are important in the current century in order to avoid the complicated issues one’s death can create. Ethical issues such as life sustaining treatment must be adopted only with the proper consultation with the patient and the relatives. Keeping the patient central in all decision making, that is, respecting patient autonomy is essential to ethical care for dying patients. End of life issues - advance directives An advance directive is a kind of instructions a patient gives his doctor about the medical care he is looking for from the doctor or the hospital, if the patient is unable to make any medical decisions. “For example, the directives would describe what kind of care you want if you have an illness that you are unlikely to recover from, or if you are permanently unconscious. Advance directives usually tell your doctor that you don't want certain kinds of treatment. However, they can also say that you want a certain treatment no matter, how ill you are” (American Academy of Family Physicians) Only the patient has the authority over his life apart from the creator God. Since the creator remains silent, only the patient can take decisions whether to go for aggressive treatment options in order to save his life. These aggressive treatment options may be expensive and painful. Moreover there is no guarantee for the success also. Under those circumstances the doctors must explain everything about the treatment to the patient so that he can independently take a decision whether to opt it or not. “Sometimes, in spite of treatment, a condition or illness will cause death. In those cases, patients can decide what they do and do not want done. They can decide whether they want aggressive treatment that might prolong life or whether they prefer to stop treatment, which could mean dying sooner but more comfortably.” (End of Life Issues) Advance directives can eliminate the agony of relatives whether to opt for the risky treatment options or not if the patient happens to be unable to take decisions. Any person who has completed 18 years of age can prepare an advance directive. The current world situations show that anything can happen to anybody at any time. Accidents and unknown diseases are increasing day by day and in most cases the patients become unconscious and hence the doctors may not be able to discuss the treatment options with the patient at an emergency stage. Advance directives can be written in several ways. Some of the common methods are; Use a form provided by your doctor, Write your wishes down by yourself, Call your health department or state department on aging to get a form, Call a lawyer, and Use a computer software package for legal documents. (American Academy of Family Physicians) An advance directive can be changed any time if the patient has normal physical and psychological health needed for thinking rationally. The only requirement is that the changes made to the advance directive must be legalized as per the laws of the state you are staying. Even if the patient was not able to change his advance directives, when he was healthy for some reasons, he can do that even at the hospital by telling the changes needed clearly to the doctor or his relatives. In any case the patient should have the adequate mental and physical health at the time of changing his advance directives. End of life issues - living will The living will is one of the oldest forms of advance directive. ‘A living will written, legal document that describes the kind of medical treatments or life-sustaining treatments the patient would want if he was seriously or terminally ill. A living will doesn't let you select someone to make decisions for you.’ (American Academy of Family Physicians) A living will can be specific or general. A living will usually explains what the doctor must do in case the patient happens to be in a critical stage. Living wills also advice the doctors, whether to sustain his life using medical equipments or any other means, if the doctors give up the scope of recovery. Most of the living wills written found to be defective and also made the things more complicated because of people’s unawareness about the proper methods of writing a living will and hence another advance directive has recently developed; the durable power of attorney. End of life issues - durable power of attorney A durable power of attorney (DPA) for health care is another kind of advance directive which states, whom you have chosen to make health care decisions for you. It becomes active any time you are unconscious or unable to make medical decisions. (American Academy of Family Physicians) DPA will come into exist only when the patient become critically injured or conscious and may not be able to take independent decisions. The patient can trust somebody and can authorise him for taking decisions about his future in case of a critical state through durable power of attorney. For example, a person can trust either his wife or children and can authorise one of them to take decisions about his future treatment options if he becomes unable to take decisions. A DPA is generally more useful than a living will because of the convenience and flexibility it provides to the doctors and the relatives about the future course of treatment. Durable power of attorney may not be a good choice if the patients don’t have another person he may trust to make these decisions for him. End of life issues – DNR A do not resuscitate (DNR) order is another kind of advance directive. A DNR is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. (American Academy of Family Physicians) Medical science has advanced to a level in which even the heart beats can be regained using medical equipments, once it stops. The patient can decide in advance whether he needs to utilize such equipments to regain his heart beats or to sustain his life. So people due to their religious beliefs may not go for such equipments in order to prolong their life. Ethical issues -life sustaining treatment “Family members are often asked to make decisions on behalf of a loved one who is seriously ill without having a complete understanding of his or her preferences. To avoid this situation, older adults should discuss their end-of-life wishes with family members and health care providers well before the onset of a serious illness, and they should designate a surrogate decision maker for health care” (Planning for the End of Life—An Emerging Public Health Priority) Britain’s famous celebrity Joe Goody is who has passed away recently because of blood cancer is the best recent example we can remember regarding this topic. She has celebrated even her death and saved lot of money for her children by avoiding expensive treatment options and also she was able to earn more money by selling out the telecast rights of her last moments. Doctors actually revealed her conditions clearly and offered Joe Goody some better treatment options in America, but Goody refused it, opting for the natural death. Conclusions Advance directives are a better option for both the patient and the doctor in order to decide upon the future course of treatment in case of an emergency. The patient can either create a living will, durable power of attorney or a DNR to make the doctor and the relatives aware of his future death or treatment plans. Doctors need more training in dealing with aged persons as far as medical profession is concerned. Most of the doctors who treat the aged have no clue at all regarding how to tackle the patients under no hope situations. Ethical issues are more prevalent under such circumstances, but the doctors are not equipped with the solutions for a patient under no hope situation. References 1. American Academy of Family Physicians, 2009, Retrieved on May 2, 2009 from http://familydoctor.org/online/famdocen/home/pat-advocacy/endoflife/003.html 2. End of Life Issues, Retrieved on May 2, 2009 from http://www.nlm.nih.gov/medlineplus/endoflifeissues.html 3. Planning for the End of Life—An Emerging Public Health Priority, Retrieved on May 2, 2009 from http://www.cdc.gov/Aging/EOL.htm Read More