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3. Literature review of palliative care
3. Literature review of palliative care
Essays on advance care directives
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People with life-limiting illness may prefer a variety of needs, and access to those needs is significant especially in promoting their quality of life. These needs may include comfort, cultural and spiritual as reflected on Dorothy’s desires. However, ethical issues arise when a person decided to withdraw life-long treatment and at the same time, respecting an individual’s values and wishes and what it means by quality of life to the person. Therefore advance care planning is vital.
An individualised care plan is beneficial in planning for end of life care that is according to patient’s best interests. The best interest should be assessed in recognising the importance of person’s preferences, values and beliefs and, as a consequence, underpins
However it can also make room for medical, legal and ethical dilemmas. Advances in medical technology enable individuals to delay the inevitable fate of death, overcome cancer, diabetes, and various traumatic injuries. Our advances in medical technologies now allow these individuals to do things on their own terms. The “terminally ill” state is described as having an incurable or irreversible condition that has a high probability of causing death within a relatively short time with or without treatment (Guest, p.3, 1998). A wide range of degenerative diseases can fall into either category, ranging from, HIV/AIDS, Alzheimer’s disease and many forms of cancer. This control, however, lays assistance, whether direct or indirect, from a
This ethical scenario presents an 86 year old female with numerous health issues and chronic illnesses. Mrs. Boswell’s advancing Alzheimer’s disease makes it extremely difficult to initiate dialysis, leading her physician to conclude a poor quality of life. The ethical dilemma portrayed in this case is between non-maleficence and autonomy. Health care workers should focus on promoting the patient’s overall wellbeing and weigh the benefits and risks of the course of action, while also considering what the family declares they want done. Since the patient is deemed unable to make decisions, the goal is to collaborate with family, assess patient quality of life, address prognosis, and establish realistic care goals.
The family of Jahi has experienced limited resources as well as limited possibilities, however the quality of life has a strong hold on the medical decisions made by the family. According to Johnson and Rhodes (2010), quality of life (QOL) is one of the main focuses by the hospice movement (p. 64). It is known as the general well being of individuals and societies. This includes fields of international development, healthcare, and politics. The consideration of quality of life in making medical decisions regarding healthcare may involve judgments about the worth of life, and that ...
Wiener, Lori, Elizabeth Ballard, Tara Brennan, Haven Battles, Pedro Martinez, and Maryland Pao. 2008. "How I wish to be remembered: the use of an advance care planning document in adolescent and young adult populations." Journal Of Palliative Medicine 11, no. 10: 1309-1313. MEDLINE with Full Text, EBSCOhost (accessed May 26, 2014).
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.
Through his discussion of quality of life and death, Singer offers ethical guidelines for the decision to refuse treatment to prolong life in the case of a terminal illness.
Thanks in part to the scientific and technological advances of todays’ society, enhanced medicinal treatment options are helping people battle illnesses and diseases and live longer than ever before. Despite these advances, however, many people with life threatening illnesses have needs and concerns that are unidentified and therefore unmet at the end of life, notes Arnold, Artin, Griffith, Person and Graham (2006, p. 62). They further noted that when these needs and concerns remain unmet, due in part to the failure of providers to correctly evaluate these needs, as well as the patients’ reluctance to discuss them (p. 63, as originally noted by Heaven & Maguire, 1997), a patient’s quality of life may be adversely affected. According to Bosma et al. (2010, p. 84), “Many generalist social work skills regarding counseling, family systems, community resources, and psychosocial assessments are relevant to working with patients and families with terminal illness”, thereby placing social workers in the distinctive position of being able to support and assist clients with end of life decisions and care planning needs. In fact, they further noted that at some point, “most social work practitioners will encounter adults, children, and families who are facing progressive life limiting illness, dying, death, or bereavement” (p. 79).
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.
One of the greatest dangers facing chronic and terminally ill patients is the grey area regarding PAS. In the Netherlands, there are strict criteria for the practice of PAS. Despite such stringencies, the Council on Ethical and Judicial Affairs (1992) found 28% of the PAS cases in the Netherlands did not meet the criteria. The evidence suggests some of the patient’s lives may have ended prematurely or involuntarily. This problem can be addressed via advance directives. These directives would be written by competent individuals explaining their decision to be aided in dying when they are no longer capable of making medical decisions. These interpretations are largely defined by ones morals, understanding of ethics, individual attitudes, religious and cultural values.
The individual will need to be encouraged to make decisions about the care they receive and the type of life they want to live and also ensure that their families are part of the decision making process.
While navigating the abundant and sometimes confusing legal language of advance directives can be time consuming, it would benefit every person to consider their end of life wishes and have some form of written statement available for their doctor and family to understand those wishes. Doing this in advance can prevent emotional anguish, suffering and expensive litigation. In the end, clearly and when possible, written, documentation of a medical directive, a living will, or a chosen health care power of attorney will lessen the burden for the medical professionals and family of a dying or incapacitated person.
A ‘good death’ is something that can help us to evaluate how to formulate improved end-of-life care, free from discrimination regardless of a person’s social level with no stereotyping. Learning to respect difference and diversity and to ensure that everyone is treated as equals with their end-of-life care. Diversity is a concept that forms acceptance and respect of individual differences. Whereas, difference gives us variations within the connection of control leading to
Overall the need for a better based end of life care strategy is warranted globally. More of a focus should be given on care and high quality service for patients. As of now too much decision lies with the healthcare professionals and this can lead to faulty decision making because the health care providers are doing what they believe is in our best interest. In reality the patient or ourselves only have the true idea how we would like our final days to be carried out. By developing and carrying out an end of care plan we can take the decision making out of the family and doctors and place it on the patient. By all counts the need for change is apparent within the healthcare industry in regards to end of life care. By considering this unique change a great deal of improvement can be derived from this decision making process.
THOMAS, K. and LOBO, B., 2011. Advance care planning in end of life care. Oxford: Oxford University Press.
Advancements in medical technology are made every day. Diseases are being cured, and better treatments are becoming available for the diseases that are not. As a result, people are living longer, and some medical problems that once killed, now do not. Almost anyone would agree that living longer would be great, but for patients’ suffering from dementia, Alzheimer’s, or any other debilitating disease, a longer life is just more time to suffer. Prolonged life has become a topic of ethical debate, and there are many things to be considered when discussing it.