Death and Dignity - Research Paper Example

Death and Dignity Introduction In July 2008, the UK government launched a decade long strategy for end of life care. In accordance with this strategy, the National Health Service is required to provide new services, modify the extant services, and ameliorate standards and training, in order to ensure better care for people at the end of their life. The Marie Curie Cancer Care charitable organisation conducted a survey, in which 67% of the respondents expressed a desire to leave the mortal coil at home. All the same around 58% die in hospitals. The objective of this strategy is to ensure that a larger number of people are their place of choice, at the time of their passing away (Hitchen 2008: a2999). A significant number of the people who die in the UK, are above 75 years of age. Most of these deaths transpire in the hospital, subsequent to affliction with cancer, stroke, cardiac ailments, neurological disorders or dementia. Providing care for the terminally ill is not only a rewarding experience, but it also provides untold satisfaction. The quality of such care, provided by the National Health Service has not been satisfactory (End of Life Care Strategy - Executive Summary, 2008). Therefore a new strategy was proposed. This novel policy is expected to provide better access to health care of a superior order, to individuals whose end is drawing near. This initiative is to be independent of several factors, such as, sexual orientation, economic status, gender, age, ethnicity and religious disposition of the patient. Such exemplary health care is to be provided, irrespective of the location of the patient, which could be his home, a care home, or a hospital (End of Life Care Strategy - Executive Summary, 2008). Question 1 People have a right to die with dignity, and to this end their requirements, predilections and wishes are to be taken into consideration. Thereafter a care plan that incorporates these factors is to be formulated and implemented. On occasion, there will be terminally ill patients, who do not desire to undergo any further treatment. Some of these patients may apprehend that as their disease progresses they would no longer have the capacity to refuse treatment (End of Life Care Strategy - Executive Summary, 2008). Other patients could specify the nature of the care that is to be provided to them, and the place where they would prefer to die. These details are to be incorporated into the care plan. This care plan should be periodically reviewed by the patient, carers and a multidisciplinary team of professionals, whenever the patient’s medical condition undergoes a change or the patient expresses a desire for change in the plan (End of Life Care Strategy - Executive Summary, 2008). The best results of a care plan are obtained, when it is made available to everyone who should legitimately have access to it. In general, a good death entails being treated with dignity and esteem; not having to undergo pain or other distressing symptoms; being placed in familiar environs; and provision with the company of near relatives and friends. Unfortunately, the number of people who obtain a good death is limited. There are many patients, who are unnecessarily subjected to pain and other unwanted symptoms. In addition, there are several patients who have been subjected to indignity and disrespect (End of Life Care Strategy, 2008). Moreover, there are many people who die in a manner that is not to their liking. The National Council for Palliative Care and the Department of Health are to cooperate with each other, in order to transform the existing attitude to the phenomenon of death in society, and to engender a national coalition that will improve end of life care. It is essential to properly evaluate the requirements of individuals who are at the end of their sojourn on this planet (End of Life Care Strategy, 2008). Their preferences and wishes should be discussed and incorporated in a care plan. Question 2 In our case study, the patient expressed a desire to spend end of life in his home surrounded by his people. The following discussion discloses the funding procedures by the NHS to patients on end of life care. On the 16th of July 2008, the Health Secretary of the United Kingdom launched the End of Life Care Strategy. This initiative has been provided with £ 286 million in funds, so that it provides exemplary care for people who are nearing death. Furthermore, its objective is to provide greater choice, regarding where a person approaching death, is to live and die. Every adult, who is suffering from advanced, progressive illness are eligible for the benefits provided by this strategy (End of Life Care Strategy, 2009). Moreover, it applies to any care providing arrangement. The National Cancer Director was the chairman of an advisory board that formulated this strategy. It included important stakeholders from social care, professional and academic organisations, and government health institutions. The Next Stage Review of the National Health Services’ health authorities had contributed significantly to end of life care, and this formed the basis for this strategy (End of Life Care Strategy, 2009). The Labour Party specified in its policy paper Building Britain’s Future it would seriously consider the establishment of a right to choose to die at home. In its manifesto, the Labour Party referred to this promise, and declared that it would work with end of life care providers, like the Marie Curie Cancer Care, to provide individuals at the end of their life, with palliative care at their home, if such be their desire (End-of-life care and decision making – a review of party policies). Continuous National Health Service care funding is provided to individuals who require ongoing care, chiefly on medical grounds and not due to general debilitation. Such care funding consists of a set of services and funding, provided by the National Health Service to people with health requirements and who are not in a hospital. Such persons can be located at home or in a care home. In addition, the provision of continuing healthcare has no bearing on the disease, condition, diagnosis, the entity that provides the care or the location where the care is made available (Long Term Care & How to Pay for it). With the introduction of a novel National Framework for the National Health Service’s Continuing Care, on the 1st of October 2007, a new Decision Support Tool has been provided. The latter makes it possible to evaluate more equitably, the entitlement of an individual to free continuing care, under the auspices of the National Health Service. This tool aims to preclude conflicting decisions regarding eligibility for such free long term care (Long Term Care & How to Pay for it). It is the task of the relevant Primary Care Trust to determine such eligibility. Not to be outdone, the Conservative Party published a policy paper, namely, The National Health Service – Delivering our commitment, which recommends the inclusion of measures to coordinate hospice support with community and primary care in the government’s review of end of life care. This paper has also suggested that palliative care providers are made available, round the clock, throughout the nation. (End-of-life care and decision making – a review of party policies). Moreover, this paper has highlighted the necessity to extend end of life services to every category of patient. According to the discussion, in our case study, palliative care should be provided to the terminally ill patient, as specified in the policy on care at home. Question 3 In the year 2005 the UK government had made some commitments to the denizens of the UK, by means of its manifesto. These promises are to be fulfilled by the government by the year 2011. Specifically the commitment in respect of palliative care was to double the governmental investment. This would result in the provision of better care for the patients, and this would be achieved by allowing people to exercise their choice, regarding end of life care; and ensuring dignity and respect for them, achieving a proper coordination of the various health care services and by providing the necessary support to carers (End of Life Care Strategy, 2009). Social capital and its mobilisation are important facets of any production process; and the basic goals may change substantially, depending on the situation. In the context of social enterprises, social capital gets concentrated around endeavours that entail significant community service (Boizaga & Defourny 2004: 319). No collective project can develop, in the absence of the mobilisation of social capital. Moreover, the participants, in collective projects develop a keen sense of belonging to their specific community. This transpires due some form of inherited affinity or due to developing a venture, wherein their civic identity causes them to act. This is a collaborative way of performing some act, and it transcends strategy, thereby generating the possibility for greater mutual understanding (Boizaga & Defourny 2004: 319). There is a sense of belonging to a group that clearly perceives that they have the same objective. The Social Work Inspection Agency has prescribed a six point scale, and this scale has been adopted by the multi – agency inspections conducted, in respect of the services offered to the older individuals. These appraisals pertain to the cooperation between the services related to social work and health care associations. As a consequence, there could be a modicum of discrepancy betwixt these assessments and the evaluations of the Social Work Inspection Agency performance inspections (Collaborative working across services for older people in Tayside, 2007). In our case study, the patient expressed his wish to undergo a home care plan. As discussed above, such services entail considerable coordination among the various participants, like home care providers and health care agencies. Social capital renders the involvement of the people proactive. Hence, it is indispensible to mobilise social capital for the successful implementation of care at home, as required by the patient. Question 4 A number of short comings were identified in the processes of implementation of the end of life care plans. The following discussion reveals the problems with health care providers and other pertinent entities, in implementing these policies. A serious allegation has been made against the National Health Service, namely that it fails to satisfy even the basic needs of the majority of those whose life is drawing to a close. This was corroborated by several research studies and the investigations conducted by the Healthcare Commission. It was observed in these studies that dignity and respect were very infrequently provided to individuals who were on the brink of death (Comptroller and Auditor General National Audit Office, 2008). Furthermore, it was reported to the House of Commons by the Comptroller and Auditor General that the quality of social service provision and hospital care, in respect of care plans for patients was dismal. It was also observed by this report that care plans had neither been formulated nor agreed upon. The consequence of this callous attitude of the National Health Service was that people on the verge of death and their carers were compelled to countenance unnecessary stress (Comptroller and Auditor General National Audit Office, 2008). Although, every carer is entitled to being provided an evaluation, in respect of health and social care requirements, it was seen that a mere 29% of the Public Care Trusts made such an assessment available to the carers. In addition, these Public Care Trusts do not maintain a proper record regarding the assessments provided by them to carers. Despite the fact that respite care is of great assistance to carers, just 24% of the Public Care Trusts admitted to providing such succour (Comptroller and Auditor General National Audit Office, 2008). Moreover, the number of health care professionals provided with end of life care is inadequate. For instance, just 29% of the doctors and 18% of the nurses had been trained in this area. There is much to be desired, regarding the quality of communication provided by doctors and nurses to patients whose life is about to end. For instance a mere 39% of the doctors and 15% of the nurses had been trained in such communication (Comptroller and Auditor General National Audit Office, 2008). 90 care homes participated in a survey conducted by the Comptroller and Auditor General’s office, and of these 74% admitted to providing training on end of life care. However, this training was not compulsory. In addition, the Skills for Care collected data in 2007, which showed that just 7% of care home workers and 5% of nursing care home workers had undergone training that related to the provision of support to individuals on death’s doorstep (Comptroller and Auditor General National Audit Office, 2008). There is considerable divergence between the pattern of need and the expenditure incurred on services related to specialist palliative care, by the Public Care Trusts. Thus, substantial disparity was noticed in the amount expended on such care, with respect to patients on the verge of death. Specifically, this amount varied from £154 to £1,684, per individual (Comptroller and Auditor General National Audit Office, 2008). The substandard quality of service provided by the National Health Service and social care organisations to those nearing the end of life, is the principal cause for many people to prefer death at home, especially when there is no explicit reason for such people to end their life in a hospital. The provision of adequate training to social care and National Health Service personnel, in the context of end of life care, could change this situation drastically, and a larger number of people could breath their last at home, a care home or a hospice (Comptroller and Auditor General National Audit Office, 2008). Conclusion The End of Life Care Strategy cannot realise optimal outcomes, in every situation over the short term. The task of striking a balance between improving standards of end of life care and delivering on entitlements has proved to be onerous. Thus, the End of Life Care Strategy has to establish minimum standards and also generate the necessary motivation for exceeding these minimum standards (End of Life Care Strategy Hospice recommendations, 2007). The fundamental aim of this strategy should be ensuring good dying and death for all the citizens of the UK. A number of entitlements have been identified by this strategy. Additional research is required to determine which of these entitlements are apt and feasible in an end of life scenario. Some of these entitlements are the provision of a specific coordinator, from the diagnosis stage; and the development of a sophisticated care plan, after the commencement of care, which includes safeguards to prevent the care plan from being disproportionately perfunctory (End of Life Care Strategy Hospice recommendations, 2007). Some of the other important entitlements envisaged by this strategy are the provision of information by healthcare professionals who possess the relevant knowledge; and perhaps most importantly, the right to exercise a choice regarding the different facets of end of life care, such as, the provider, location and treatment, and the choice to obtain such care from the entity of one’s choosing, rather than what is provided by a local authority (End of Life Care Strategy Hospice recommendations, 2007). A close collaboration between the Primary Care Trusts and the Local Authorities is indispensable for improving end of life care. In this endeavour, the active participation of care homes, hospices, faith groups, and care providers from the independent and voluntary sectors, has to be ensured. The principal requirement is to ensure that there are common entitlements in end of life care that are independent of a specific environment. This is indispensable for enhancing uniformity of services and bettering the quality of such care (End of Life Care Strategy Hospice recommendations, 2007). A vast improvement in palliative care, especially with regard to those nearing the end of their life, can be achieved by improving the skill and knowledge levels of the attending personnel. Moreover, there has to be better communication and cooperation between the various entities, such as the National Health Service, the voluntary sector and social services, which are involved in the provision of end of life care. Such skills and competence primarily emerged from the palliative care provided to cancer patients who were terminally ill (Comptroller and Auditor General National Audit Office, 2008). This competence admits of extrapolation to other terminally ill patients and the care homes, by the provision of relevant training and outreach services. List of References Boizaga, C., & Defourny, J. (2004). The emergence of social enterprise. Routledge. Collaborative working across services for older people in Tayside. (2007, May). Retrieved May 23, 2010, from Social Work Inspection Agency: http://www.pkc.gov.uk/NR/rdonlyres/5AC674DC-B7C7-4C56-AF98-A4FA0B627E88/0/TaysideMAISOP2007pdf.pdf Comptroller and Auditor General National Audit Office. (2008). End of Life Care. London: The Stationery Office. End of Life Care Strategy - Executive Summary. (2008). Retrieved May 22, 2010, from Department of Health: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_086437.pdf End of Life Care Strategy. (2008, July). Retrieved May 22, 2010, from Department of Health: http://www.endoflifecare.nhs.uk/eolc/files/DH-EoLC_Strategy_promoting_high_quality_Jul2008.pdf End of Life Care Strategy. (2009). Retrieved May 22, 2010, from NHS: http://www.endoflifecare.nhs.uk/eolc/eolcstrat.htm End of Life Care Strategy Hospice recommendations. (2007, June 22). Retrieved May 23, 2010, from help the hospices: http://www.helpthehospices.org.uk/enewsletter/documents/EOLCS_Hospice_Recommendations.pdf End-of-life care and decision making – a review of party policies. (n.d.). Retrieved May 23, 2010, from Dignity in dying your life, your choice: http://www.dignityindying.org.uk/includes/spaw2/uploads/files/A%20review%20of%20party%20policies%20on%20end-of-life%20care.pdf Hitchen, L. (2008). Monitoring is vital for government’s end of life care strategy to be successful. 337 British Medical Journal , a2999. Long Term Care & How to Pay for it. (n.d.). Retrieved May 23, 2010, from Advice on Care: http://www.adviceoncare.co.uk/free-care.htm Read More