“Near the end of life, individuals often become too ill to express their wishes about the use of life-sustaining medical treatment. Instructional living wills, also known as advanced directives, are widely advocated as a solution to this problem based on the assumption that healthy people can predict the types of medical treatment they will want to receive if they become seriously ill” (Ditto, 2005, 481). In general, living wills raise much controversy. There are ethical, legislative, religious, emotional, and medico-legal issues that have been debated over for many years. It is an individual’s personal decision whether or not to choose to record a living will for future circumstances. A living will can be of great value, especially in extremely stressful situations, such as when a person falls into a persistent vegetative state. “Essentially, for a definitive diagnosis of vegetative state, lack of any evidence of awareness of self and/or the environment across serial assessment(s) and setting(s) would be warranted” (Wilson, 2005, 432). In these occasions, if a person does not retain a living will, their wishes of the healthcare they would prefer would be in the hands of someone else. To eliminate unnecessary problems and consequences on others, some people feel it is wise to formulate and execute a living will. A living will should have requirements that can be carefully examined and easy to understand to represent exactly what a patient’s wishes are incase his or her health expiry is in a state where the laws are not the same as the state in which that patient’s living will was filed. Thus, if a patient has a living will and falls into a persistent vegetative state during the decision making process, only his or her wishes shou... ... middle of paper ... ...e outdated or inapplicable to the specific circumstances” (Schatz, 2010, 4). There are three different options of a healthcare proxy in a patient’s living will. First, the healthcare proxy does specify what is in the living will of their patient. Second, they must obey what is written in the living will and if any other decisions shall be made, the healthcare proxy has the authority to do so. Thirdly, the patient has written a living will but has disregarded it and turned to the healthcare proxy to make any decisions when it is necessary or when they seek fit to do so. Good communication skills, as well as specific requests, before they fall into ill health, with their caregivers and family will help simplify vast emotional issues for the ones of the patient left behind. This may also remove any hardship on the patient’s medical team that they would have to undergo.
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
Once I explained exactly what a living will is because some were unaware they were very comfortable with the idea of filling out a living will. The responses that I got all varied to different degrees. My brother stated that he did not yet have a living will but that they are very important to have and everyone should get one. He said that his wishes would be to pretty much “pull the plug in every circumstance”. He absolutely did not want to be put on life support, be artificially supplied with food, or get life sustaining drugs, machines, or other medical procedures. My mother had wishes the same as I would have which is to consider the circumstances and give me a month to evaluate if I have the possibility of making a full recovery. If there is no hope of having a full recovery then I want all life sustaining measures to be stopped because I don’t in any way want to be a burden on
Signing for the treatment, procedures, medications. He or she has the right if the patient death the appointee has the right to order where the burial should take place. The family members in this case have zero rights, they are unable to exercises any thing because of the legal stand point of the living will. But if the patient in question has no living will under the different laws the person in command is her or her spouse if there is no spouse. The next in commander is his or her children’s.
As we get older and delve into the real world, it is important to start thinking about end-of-life care and advance directives. Although it is something no one wants to imagine, there is an absolute necessity for living wills and a power of attorney. Learning about the Patient Self-Determination Act and the different legal basis in where you live is important because it will help people understand why advance care directives are so important. Although there are several barriers in implementing advance care directives, there are also several actions that healthcare professionals can take to overcome these obstacles. These are also important to know about, especially for someone going into the medical field.
Social Attitudes Survey noted that 78% of respondents believe that “the law should require doctors to carry out the instructions of a Living Will” (Park et al, 2007). These decisions become important once patients lose their mental capacity, are unconscious, or unable to communicate” (BMA, 2009). The Mental Capacity Act 2005 defines an “advance decision” as a decision made by a person 18 or over, when he or she has the capacity to do so. The implications of a Living Will, make the case against legalising assisted dying weaker. This is because if a person is legally allowed to set out which treatments they will or will not agree to, and can refuse life sustaining treatments by creating a legal document, then why shouldn’t an individual in extreme pain who is able to make the request at the time be able to ask for assistance in
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).
End-of-life care in the United States is often fraught with difficult decisions and borne with great expense. Americans are often uncomfortable discussing death and
The idea of “Outliving Oneself” depends on the concepts of trauma and most importantly the self, in a situation where said trauma obliterates the self for an indefinite amount of time. Brison presents the self in three interwoven parts: the embodied self, the self as narrative, and the autonomous self. Any of these parts of self depend largely on the individual’s society, culture, and interactions with other people. The embodied self represents the self in conjunction with the physical body, which our society separates from the self, to intimate a soul or personality, and also assigns genders to certain traits. Trauma dissolves this separation of body and mind because violence brings the traumatized to face their own mortality. They have to see their body as an object because their assailant treats it as an object. Trauma is so damaging because the self cannot exert any power whatsoever; the interaction between the assailant and the victim, essentially a social situation, robs the victim of a voice, because the assailant ignores it, a personality, because it is of no consequence to the assailant, and a self, because the assailant uses the body as an object, and the body plays a more central role in the interaction than the self does. Brison quotes Cathy Winkler in saying a rape is a “social murder,” because the rapist’s part in the interaction defines the victim through their actions that take away the victim’s sense of self. Any control that the victim felt over their body gets taken from them by the rapist. The consequences of this trauma include a loss of control over physiological functions, such as emotion and incapacitation from anxiety; the body and mind are out of balance, which leads the victim to be stigmatized by societ...
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.
One of the many concerns is allowing incompetent individuals making this irreversible decision, which is why, “all have agreed that this end-of-life option should apply on to competent individual’s”(113). In addition, people opposed to this method argue that patients demanding this process are suffering from depression and not able to make decisions; yet, Rosenfled explains that practitioners most ensure that patients who consent to this medical intervention do it voluntarily, knowingly and
In What Dying People Want, Kuhl comments, "Dying involves choice"(xviii). People choose what they wear, what they do, and what they will eat on a day to day basis. Choosing how, when, or why sick people die is just like an everyday decision for them. This however, has not been accomplished by some individuals in this Country. Americans have the right of choice. When a patient communicates the desire to die, the inspection of acceptability for palliative care begins instantly. Inspections include evaluation of pain management, depression, anxiety, family burnout, spirituality and other observed issues (Baird and Rosenbaum 100). When working or living with an elder, never ignore the words "I want to die". If this is ignored, that person will not receive their wishes they deserve. Countries are starting to understand that people should be able to die if they choose, "In the United States there are assisted dying laws restricted to terminally ill and mentally competent adults" (Firth). The assisted dying law is only in Oregon, Montana, Washington, Vermont, and California. That is five states out of fifty states. This must be expanded to all fifty states because all individuals have the right of this law. In 2013, Vermont passed an "End of Life Choices" bill. This bill allows terminally ill people to get
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.
The care of patients at the end of their live should be as humane and respectful to help them cope with the accompanying prognosis of the end of their lives. The reality of this situation is that all too often, the care a patient receives at the end of their life is quite different and generally not performed well. The healthcare system of the United States does not perform well within the scope of providing the patient with by all means a distress and pain free palliative or hospice care plan. To often patients do not have a specific plan implemented on how they wish to have their end of life care carried out for them. End of life decisions are frequently left to the decision of family member's or physicians who may not know what the patient needs are beforehand or is not acting in the patient's best wishes. This places the unenviable task of choosing care for the patient instead of the patient having a carefully written out plan on how to carry out their final days. A strategy that can improve the rate of care that patients receive and improve the healthcare system in general would be to have the patient create a end of life care plan with their primary care physician one to two years prior to when the physician feels that the patient is near the end of their life. This would put the decision making power on the patient and it would improve the quality of care the patient receives when they are at the end of their life. By developing a specific care plan, the patient would be in control of their wishes on how they would like their care to be handled when the time of death nears. We can identify strengths and weakness with this strategy and implement changes to the strategy to improve the overall system of care with...
“Please tell me: isn’t God the cause of evil?” (Augustine, 1). With this question to Augustine of Hippo, Evodius begins a philosophical inquiry into nature of evil. Augustine, recently baptized by Saint Ambrose in Milan, began writing his treatise On Free Choice of the Will in 387 C.E. This work laid down the foundation for the Christian doctrine regarding the will’s role in sinning and salvation. In it, Augustine and his interlocutor investigate God’s existence and his role in creating evil. They attempt not only to understand what evil is, and the possibility of doing evil, but also to ascertain why God would let humans cause evil. Central to the premise of this entire dialogue is the concept of God, as relates to Christianity; what is God, and what traits separate Him from humans? According to Christianity, God is the creator of all things, and God is good; he is omnipotent, transcendent, all-knowing, and atemporal- not subject to change over time- a concept important to the understanding of the differences between this world and the higher, spiritual realm He presides over. God’s being is eidos, the essence which forms the basis of humans. With God defined, the core problem being investigated by Augustine and Evodius becomes clear. Augustine states the key issue that must be reconciled in his inquiry; “we believe that everything that exists comes from the one God, and yet we believe that God is not the cause of sins. What is troubling is that if you admit that sins come from… God, pretty soon you’ll be tracing those sins back to God” (Augustine, 3).
"Whose life is it, anyway?" A Plea stated by the late Sue Rodrigues. Rogrigues, a high-profile, terminally-ill resident of British Columbia, Canada, suffered from a terminally ill disease (Robinson, 2001). She was helped to commit suicide by a physician in violation of Canadian law. Many people, like Rodrigues, want to be in control of their final days. Terminally ill patients have a terminal disease and do not want to diminish their assets by incurring large medical costs as their death approaches (Robinson, 2001). As an act of generosity, they would rather die sooner, and pass on their assets to their beneficiaries. A serious disorder or disease has adversely affected their quality of life to the point where they no longer wish to continue living (Johansen, 2000). Myself, along with many other United States citizens believe that euthanasia should be legalized within the United States for reasons concerning medical advances, the severity of pain a person is in once diagnosed with a terminal illness, and the basic fact that a person’s life is their own life and no one else’s.