Artificial Hydration at End of Life - Term Paper Example

Running Head: Artificial Hydration at End of Life Student’s Name: Instructor’s Name: Course Code and Name: University: Date Assignment is due: Artificial Hydration at End of Life Introduction There is a huge literature evidence of considerable differences in practice when using hydration at the end of life for clinicians. While some professionals in healthcare see it as a great part of the management strategy, there are numerous others who consider it a needless burden and have a belief that permitting natural dehydration rarely causes distress in patients and may even be of substantial benefit. There is only limited body of research on the issue of artificial hydration at End of Life; therefore, clinical experience appears to be providing the ideal basis for current practice. Nevertheless, what the existing research clearly tells us is that in situations when a person is requesting fluids and conscious enough, it should never be denied. Conversely, if the patient is slipping in and out of a certain level of consciousness and the team agrees that he is likely to die in a few hours time, some scholars argue that hydrating a patient artificially can have a burdensome and negative effect on the quality of life. This paper previews 6 articles with a critical discussion of the findings within the articles on this current issue on artificial hydration. From the 2 nationwide surveys done by Miyashita (2007) on nurse and physician attitudes toward hydration for lethally ill cancer patients in Japan, he input sizeable literature on this issue. The study was investigating physician and nurse attitudes on artificial hydration in fatally ill cancer patients comparing differences in attitudes ideally between these 2 professions as well as among Japan’s clinical settings. Since, it was more on behavior the survey was to use qualitative research methods that provide excellent results for behavioral studies. The study used the survey method with questionnaires carrying the day for data collection. It had a response rate of 79% for nurses (3328/4210) and 53% (584/1123) for physicians. From the findings, more physicians answered that hydration alleviates the thirst sensation and palliative care unit nurses answering that withholding the hydration alleviated a number of physical symptoms. From the survey, oncologists answered that hydration alleviated the thirst sensation as well as fatigue quoting that there was a need for a discussion among patient-centered teams with the inclusion of individualized decision making are fundamental. From the current best practice, the survey complies with what is on the ground since there is always an argument that dying patients should not be denied the artificial hydration as it reduces thirst and fatigue that could strain the already emaciated body. However, because of the differences identified in response, practitioners should place more emphasis on the palliative care specialists’ opinion considering a wider range of views on hydration therapy and focusing on effective hydration techniques as well as alternative interventions. David, Jennifer & Arthur (2005) in their research on appropriate Use of Artificial Hydration provided the fundamental recommendations on how to go about the practice. In their study, they incorporated qualitative research methods since they also were on an analysis of behavior among the clinicians and the families of patients. Using interviews gave ample information and feedbacks from the clinicians and the family respondents to help in completing the analysis of this particular research. The findings revealed that families of patients requiring artificial hydration should be given a chance to make decisions regarding the hydration process through an informed-consent process. In other words, they should be offered complete guidance by well-established principles. Furthermore, the patients’ rights and their families of making independent decisions regarding the artificial hydration as well as other medical treatment must be defended against financial, administrative and any legal challenges at the bedside. It revealed that a number of stakeholders, which included organizations of legal associations, medical professionals, and other health care institutions, will be of requirement in ensuring the patient’s right defense. It was recommended from the research findings that even with the advocacy activities, institutions handling the artificial hydration must guarantee that all patients forgoing the hydration receive high-quality and compassionate care. Applying the findings and research recommendations to the current practice, it is practical that these are the ethical considerations that apply to the practice particularly ensuring high-quality hydration. However, patient’s rights remain a dilemma since most of at such a state do not have anybody to sign for the artificial hydration and they are in an unconscious state making it a challenge within the practice. More literature comes from Robert (2005) who discusses the weighty issues, which relate to end-of-life care considering the legal, medical and ethical issues from a historical perspective. The purpose of undertaking this research was to evaluate the ethical, medical and legal progress in the practice of artificial hydration particularly in end-of-life care. Robert addressed crucial issues in the principle application to clinical cases revealing how the practice should be carried through. His study was based majorly on observations in clinical settings to analyze and evaluate the hypothesis that clinicians follow the ethical, medical and legal policies in administering artificial hydration. He was quick to note that despite the progress and the policies guiding the clinicians, there still remain unresolved issues regarding the effectiveness and scope of personal decision making in artificial hydration process as well as the proper use of measures in the last resort in terminal care. He also involved a historical analysis in his methodology revealing the interrelation between legal and moral reasoning as well as their differences. This was to disclose developments in the legal and moral realms, which recognize rights of the patient regarding treatment decisions. He pin pointed in his findings that there are still outstanding problems in the application of ethical and legal principles to particular cases in the care of the dying patient. The problems are complicated precisely by poor or inadequate physician-patient communication, the advance directives ineffective use and the impact of the economy on the ideal, comprehensive palliative care. Precisely, he was on the point bearing the fact that it is the same case with the current practice. This is because some circumstances force clinicians to make decisions on their own as they cannot effectively communicate with patients in severe conditions. Therefore, his recommendations were calling for reforms in protecting personal dignity and rights at the end of life. Even in the current practice, a competent patient has the right to refuse the hydration process, even if it he or she may be considered to benefit from the same. However, it still remains that incompetent patients retain the right of refusal through an ideally valid advance directive and at a particular point; the clinician holds the right to make a decision for him based on assessments. It is from Robert (2008) article that the artificial hydration by clinicians learn from the recommendations for nursing practice provided. His article also looks into ethical issues involved in artificial hydration. He surveys 3 case studies in hospitals across the region using questionnaires to obtain the data. The methodology is qualitative and extremely effective as it generates enough data used in the analysis and generating findings on the current issue. His findings indicate that allowing natural dehydration at the end of life and resisting artificial hydration actively, where appropriate, is not the same with an active intent to end life and impact on neither symptom control nor survival. The evidence from the findings is that artificial hydration is competent, and one of the best in practice especially if a patient is close to death and the situation are compelling. Same case with the current practice, as a clinician, I cannot watch the patient die without using all the available options but ethical practices at times bars me from doing so without the consent of the patient. Therefore, the National Council for Palliative Care should revise the protocols and ethical issues guiding the palliative care to allow clinicians nurse make justifiable actions in artificial hydration. The National Council for Palliative Care (2007) released an article with a summary guide on Artificial Nutrition and Hydration. From the article, the analysis of the practice is justifiable in the current practice. Its findings from major case studies assert that there is a need for a practical aid for those clinicians, doctors or nurses who administer artificial hydration, with explanations of the terminologies, an ethical framework and the rights of patients. The article is a combination of five case studies that access the numerous methods of dealing with artificial hydration, from decision-makers, to practitioners administering the artificial hydration. From the article, several recommendations are made that are well applicable in the current practice and comply with the settings. It asserts that it is indispensable for anyone intending to administer artificial hydration to start discussion early, particularly where possible, with the family and the patient in determining the patient’s wishes regarding the practice. The nest positive step involved is establishing whether the patient ideally holds an advance directive so that it provides clear guidance in helping with the decision-making process. Reassuring the patient and family is also critical in the entire process since the patient’s comfort is paramount at all times. Therefore, in current based practice, such recommendations from this article are vital and of exceptional value. In a research done by Bavin (2007), it evaluates the need for artificial rehydration precisely in palliative care analyzing whether this is beneficial or not. His study involves three case studies of patients at End of Life state and the application of the artificial hydration. The method uses is practically valid as it involves interviews with the practitioners handling the patients and their perception of artificial hydration. Enough and valid data is available from the case study and helps generate findings and recommendations relating to this issue. He asserts that where dehydration results coming from a potentially correctable cause for instance overtreatment with recurrent vomiting, diuretics, hypocalcaemia or diarrhea artificial hydration remains as a valid option and practice in the short term. He also finds that there is role conflict in institutions as to who makes the decisions to administer artificial hydration in patients at such a state especially in a case whether no family is available and the patient is in an unconscious state. Therefore, he recommends that decisions on whether to administer artificial hydration on a patient should be equally judged on a day-to-day basis and the circumstances at hand. This includes weighing up the potential benefits and harms of administering the artificial hydration. He also recommends that, in cases where a decision is made and supports the practice, regular pressure relief and mouth care should be given. This goes in line with the current based practices as they guide the entire practice all along. On the same note, listening and supporting the patient is of virtue at all times. A quick note from the paper is that healthcare professionals must at all times be tactfully resistant to compromising the interests of the patient in easing the emotional distress particularly of the relatives. Conclusion There is, therefore, ample literature on artificial hydration practice and scholarly researches are of exceptional value in contributing to the literature. However, there is still more required to give an account of the current based practice and what should be remedied to develop appropriate clinical practice. A generalization of most of the findings reveals that artificial hydration should be practiced only with the consent of the patients or close family members. The policies guiding medical practice on this same issue support the same but faced with substantial challenges in current practice. This is because as reviewed many cases do not present an opportunity for practitioners to seek consent and they at times are forced to make decisions on their own. Therefore, it is evident that there is a need to in put exemptions in the established policies to also protect the practitioner. It is also a terrific way of giving them a mandate to make decisions in such situations, which therefore, would help in saving the lives of many patients at the End of Life state through administering artificial hydration. This is a positive note and would help in improving the current based practice in clinical work settings. References Bavin, L. (2007). Artificial rehydration in palliative care: is it beneficial? International Journal of Palliative Nursing, 3 (9) 4445-449. David, C., Jennifer, K. & Arthur, C. (2005). Appropriate Use of Artificial Nutrition and Hydration: Fundamental Principles and Recommendations. The New England journal o f medicine, Retrieved on 15 September 2010, from, http://www.nejm.org/doi/pdf/10.1056/NEJMsb052907 Miyashita, M. (2007). Physician and Nurse Attitudes toward Artificial Hydration for Terminally Ill Cancer Patients in Japan: Results of 2 Nationwide Surveys. American Journal of Hospice Palliative Care, vol. 24(5) 383-389 National Council for Palliative Care (NCPC) (2007). Artificial Nutrition and Hydration: Summary Guidance. London: NCPC Robert, B. (2008). Recommendations for nursing practice. In Robert, B. Providing hydration at the end of life: ethics and practice. Macmillan University Publishers, p. 136-159 Robert, F. (2005). Major issues relating to end-of-life care: Ethical, legal and medical from a historical perspective. International Journal of Social Economics, Vol. 32(1) p.34 – 59 Read More