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End of life decision making essay
Ethical issues in the end of life decisions
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“Advance care planning is about planning for the ‘what ifs’ that may occur across the entire lifespan.” — Joanne Lynn, MD (National Association of Chronic Disease, 2014) Advance care planning is planning for the “what ifs” that can occur in anybody’s life. It is not only for older adults nearing the end of their lives. These plans can be modified and restructured as living circumstances and health status change during the person’s life. Comprehensive advance care planning comprises of discussion of multiple conditions and disease trajectory (National Association of Chronic Disease, 2014). Advance care planning can probably have an effect on a great number of people as 2.3 million people die every year (Hogan 2001). It can also lessen
According to Statistics Canada Report 2013, “life expectancy in Canada is one of the highest in the world” and it is expected to grow, making the aging population a key driver to our health-systems reform. By 2036, seniors in Canada will comprise of twenty five per cent of the population (CIHI, 2011). Seniors, those aged 65 years and older are the fastest growing population in Canada. Currently there are approximately 4.8 million Canadians aged 65 or greater. It is projected that this number will increase to 9 to 10 million by 2036 (Priest, 2011). As the population get aged the demand for health care and related services are expected to increase. Currently, the hospitals in Ontario are frequent faced with overcrowding emergency departments, full of admitted patients and beds for those patients to be transferred to. It has been reported that 20% of the acute care beds in the hospital setting are occupied by patients that do not require acute hospital care. These patients are termed Alternate Level of Care (ALC). ALC is “When a patient is occupying a bed in a hospital and does not require the intensity of resources/services provided in this care setting (Acute, Complex, Continuing Care, Mental Health or Rehabilitation), the patient must be designated Alternate level of Care at that time by the physician or her/his delegate.” (Ontario Home Care Association, 2009, p.1).
Advance care planning allows a patient to identify health care preferences and surrogate decision making in the event the patient cannot make competent health decision. It promotes autonomy of patients who lack, but once possessed, the decision-making capacity. In general, there are two forms of Ads; the living will and the durable power of attorney. Nevertheless, most people, including elderly persons do not have Ads. One study of a random sample of all US deaths (N=13,883) found that only 9.8% of decedents had an AD. Patients with AD, however, were less likely to undergo cardiopulmonary resuscitation and more likely to use hospice care.
When needing to use the advance care directive, it is important that the individual’s wishes be carried out by their proxy and their physicians, no matter what their own personal beliefs are. The last action that should be taken when considering end-of-life care is that is should be reassessed periodically. This is important because an individual may change their mind about what kind of care they would want to receive as they get older.
This essay will critically analyse Care Programme Approach (CPA) assessment and care plan in an OSCE I undertook. By utilising the CPA and sources of current literature, I hope to demonstrate my knowledge and understanding in relation to this skill as well as identifying areas with scope for learning.
The first journal article is about advance care planning (ACP) in palliative care. This is of interest due to several clinical experiences and the realization that many families either ignore the patient’s request for end of life (EOL) care or who have no idea of how to plan for EOL care. By reading the research and understanding the methods used, this will allow for insight into how to implement palliative care into clinical practice across different sites. The authors of this original research are Jeanine Blackford PhD, RN, senior lecturer at La Trobe University in Australia, and Annette Street PhD, associate dean of research and professor of cancer and palliative care studies. According to Blackford & Street (2011), this research is important as there are many countries that “report a low percentage of people who have completed an advance care plan” (p. 2022), and ACP is needed upon admission to facilities that offer palliative care.
Care plans are documents where daily requirements and preferences for care and support for individuals are detailed. Since person-centred values focuses on individuals’ needs, care plans serve as a guide for professionals and caretakers, with the aim of providing excellent service to
Mollie is the patient in our case study. Mollie lives with her daughter and son in law, both in their 70’s. A home health aide assists Mollie five days a week for three hours each day. At age 94, Mollie is an older adult, considered to be part of a vulnerable population, at risk for hearing, visual and mobility deficits. This at risk population can experience changes in cognitive or physical status making the activities of daily living difficult to perform (Meiner, 2011). As people like Mollie age, gradually becoming less able to function independently, their grown children, potential caregivers, may be preoccupied with the demands of their own lives and not prepared to care for an older
Ethical issues are “moral challenges” facing the health care profession (Stanhope & Lancaster, 2012, p. 127). Ethical issues is a major concern in the healthcare field because healthcare providers observe ethical issues every day and have to make ethical decisions. Advance directives are written documents that addressed an individual’s medical care preferences. These documents usually take effect when patients no longer can make informed health care decisions for themselves. While these documents are helpful to loved ones and health care providers, there are a number of ethical considerations that can make the development and execution of advance directives difficult (Llama, 2014). This author is a geriatric nurse that recently observed an advance directive ethical issue in the clinical setting. The purpose of this paper is to outline the steps of ethical decision-making within the seven steps for the framework. This paper will also identify the facts of the case from the perspective of each person impacted by the situation and identify which ethical principles were involved in the situation.
To “live as fully and comfortably as possible” is a key phrase in the care and treatment of a patient under hospice care. Hospice care focuses on the comfort and quality of life for a person with a terminal illness. The focus is not on a cure. A hospice care provider wants to help the patient be as pain free and comfortable as they can be, so that they can live the rest of their life as fully as possible. Unfortunately, more often than not, patients with terminal illnesses are viewed to be too frail to participate in occupations (Russell, M., & Bauh-Lampe, A., 20016). It is also true that people facing the end of their life feel helpless or depressed, lose their ability to participate in a lot of the daily activities they once enjoyed, and experience a loss of dignity. (Badger, S., Macleod, R., & Honey, A. 2016). However, with hospice care, many patients are able to find some degree of comfort, safety and control over their lives during their final days.
According to The Department of Health (2009) care planning is essentially about addressing an individual’s full range of needs. It takes into account their personal, social, economic, educational, cultural and mental health needs. After initially discussing this assignment with John
Taking this into consideration the nurse began to carry out a risk assessment and care plan to address the issues recognised. According to the National Institute for Health and Care Excellence (NICE) (2015) health and social care staff should identify the specific needs of people with dementia and their carers arising from ill health, physical disability, sensory impairment, communication difficulties, problems with nutrition, poor oral health and learning disabilities. Care plans should record and address these
Health Care workers are constantly faced with legal and ethical issues every day during the course of their work. It is important that the health care workers have a clear understanding of these legal and ethical issues that they will face (1). In the case study analysed key legal and ethical issues arise during the initial decision-making of the incident, when the second ambulance crew arrived, throughout the treatment and during the transfer of patient to the hospital. The ethical issues in this case can be described as what the paramedic believes is the right thing to do for the patient and the legal issues control what the law describes that the paramedic should do in this situation (2, 3). It is therefore important that paramedics also
THOMAS, K. and LOBO, B., 2011. Advance care planning in end of life care. Oxford: Oxford University Press.
Brunner, L.S. & Suddarth, D. S Textbook of Medical- Surgical Nursing, 1988 6th ed. J. B. Lippincott Company, Philadelphia
In conclusion, we as health care providers will ensure that your care plan is tailored to you and your own individual needs and preferences, taking into account your circumstances beliefs and priorities. We will place you central to your care plan ensuring you have all the essential information regarding your treatment, condition and illness to make certain you have the knowledge and understanding to make informed choices in regards to your treatment. In addition to this we will always respect your decisions made making certain you know the risks and benefits with each decision before consenting to any treatment.