The End-Of-Life Treatment - Essay Example

Palliative Care, End-Of-Life Decisions Summary of the case The video presents a case at the Dunedin Hospital, where the hospital’s staffs are working to improve end-of-life treatment for a patient with chronic medical conditions. In particular, the film focusses on the end of life care provided to a 65 years-old Martin Cavanagh. Cavanagh is suffering from critical incurable COPD. Dubbed A good death, the film presents that most relatives and patients with critical medical conditions tend to face various challenges attributed to lack of proper medical care models and programs. From the film, it is evident that palliative care for patients with acute conditions entails making appropriate choices, both for the patient and the care givers. For example, Martin seems to have a number of concerns that he wants the care givers to address. On the other hand, the care givers are of the contrary opinion, they posit that most patients in palliative care tend to believe to have a preconception that would often influence them to make certain improper decisions. The film presents that in the provision of palliative care, patients should be given the right to decide the circumstances under which the care givers should change goal of medical care. Additionally patients should also have a say in choosing the place and environment that they think would give them peace as they approach death. For instance, patients should be allowed to make a choice about when to switch from actively trying to prolong his life to focusing on comfort care. The films also presents that the main goals of any palliative care program should aim at reducing the actual physical symptoms and making them less troubling and more manageable. The care also tends to extend to social aspects of life where the patient is provided with the opportunity to overcome social conflicts in the quest to make his life as comfortable as possible. Ethical consideration In caring for patients with life-threatening medical conditions, there are often complex decisions to be made. As such, it is usually helpful for the care givers to develop a good understanding of the application of the ethical and legal considerations important in decision making. In the case of Mr. Martin, it is obvious that ethical consideration of making informed consent was provided to the patient. From the onset of the patient’s admission to the hospice, the doctors provided sufficient information to the patient and his family regarding the risks and benefits of each technique and treatment. The patient and his family were consequently allowed to make informed decisions. Javashvili (2007, pg. 4) contends that it is the ethical duty of the medical practitioner to disclose all available information to the patient whether adverse or not. From the case, it is also evident that the ethical consideration of futile treatment was also put into practice. In the last few days of Mr. Martins deteriorating condition, upon realizing that the patient’s health was deteriorating at a much faster rate, the medical team carried a careful assessment and evaluation, and consulted with the patient and his family about a review of the goals of care. In particular, the doctors established that major treatment was ineffective and would instead prolong the dying phase. According to Javashvili (2007, pg. 5), if a patient’s condition continues to deteriorate, and treatment is not effective, life-prolonging treatment is deemed as futile. It is unethical to subject to subject patients to futile treatment. The doctors at the hospital handling the case were ethical in their practice. Legal consideration One notable legal consideration in the palliative care evident in the film pertains to the issue of describing and issuing of drugs. According to Rosenberg et.al (2013, pg. 7), proper pain management constitutes an integral part of the palliative care. At certain stages, palliative care may call for a significant increase in the amount of pain relievers from the normal dosage. In the case of Mr. Martin, the medical team at the hospice was considerate of this legal measure. Nearly two days prior to Mr. Martin’s death, with the pronounced breathing difficulties, the care givers increased the dosage of morphine top ease obstruction during breathing. Despite the risks associated with copious morphine administration among patients’ with respiratory diseases, the short-term pain relieving effect the increased dosage, was appropriate for the palliative care patient. The hospice also took into consideration of the patient’s refusal to undergo further treatment or advanced directives. It is a legal responsibility in some countries, for palliative patient’s to make conscious decision against advanced treatment directives. In the case of Mr. Martin, the doctors operated under his directives to shift focus from life prolonging treatment to the suppression of any form of pain. The doctors adhered to these directives until the patient’s demise. Question four Considering the doctors’ careful attendance of the patient’s situation, the hospitals palliative care can be regarded as satisfactory. To begin with, right from the time the patient is admitted until the time of his death, palliative care team at the hospice overseas that the patient and his family members are consulted before making critical decisions. Bill et.al (2012, pg.36) presents that wide consultations with the patient and his family amounts to respect for autonomy. The doctor’s provision of a range of information and options to the patient is also commendable. Rosenberg et.al (2013, pg. 4) posits that only when an individual is properly informed by having received all information available on the subject matter, can he give informed consent on the clinical matters. The doctors close interactive communication with the patient is also laudable. Not only do they provide follow-up at home, but they also maintain close communication with the patient at the health care facility. In one particular incident, the doctors also offer a number of options to the patient regarding the available alternatives that the patient can opt while awaiting “a good death”. Nevertheless, communication and practice between the paramedics and the patient fell short of expectations. For instance, one of the pertinent issues entails poor prioritization of the needs of palliative care patients. The patient explains that at some point when his breathing difficulties worsened, paramedics were called to transport him to a healthcare center. However, rather than understanding that as palliative care patient, martin required comfort and management of the symptom; the paramedics directly proceeded to resuscitate him. Martin explains that the resuscitation was more painful than what he was already going through. Bill et.al (2012, pg.36) elaborates that one study established that that most paramedics have a conflicting opinion when they encounter palliative care patients who mostly need comfort and symptom management rather than resuscitation. As a palliative care giver, my main goal of palliative care will be to ensure that the patient receives a smooth pain-free end-of-life care. This goal will be centered on effective communication between the palliative health care team and the patient. The family will also be consulted and be informed about some of the critical decisions pertaining to the treatment of their loved one (Rosenberg, et.al 2013, pg. 7). Communication is important towards improving satisfaction with care, and subsequent reduction of anxiety and stress both for patients and family. References A Good Death; a film about end of life care and advance care planning. n.d. [Film] Directed by Paul Troman. New Zealand: PRN Films. Bill, L. et al., 2012. Paramedics Perceptions of Their Role in Palliative Care: Analysis of focus group transcripts. ournal of Palliative Care, 28(1), pp. 36-40. Gray, J. T. & Wardrope, J., 2007. Introduction of non-transport guidelines into an ambulance service: a retrospective review. Emergency Medical journal, Volume 24, pp. 727-736. Javashvili, G., 2007. Ethical and legal issues of Palliative care and Care at the end of life. Georgia, WA, Open Society, Georgia Foundation. McNamara, B. A., Rosenwax, L. K. & Murray, K., 2013. Early Admission o Community-Based Palliative Care Reduces Use of Emergency Departments in the Ninety Days Before Death. Journal of palliative medicine. Rosenberg, M., Lamba, S. & Misra, S., 2013. Palliative medicine and geriatric emergency care: challenges, opportunities, and basic principles. Clinics in geriatric medicine, 29(1), pp. 1-29. Smith, A. K. et al., 2009. Am I Doing the Right Thing? Provider Perspectives on Improving Palliative Care in the Emergency Department. Annals of Emergency Medicine, 54(1), pp. 86-93. Read More