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Reflection on end of life care
Reflection on end of life care
End of life care in the united states
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Atul Gawande’s book, Being Mortal, focuses on end-of-life care for patients in the American healthcare system. Gawande includes evidence along with anecdotes from his own life surrounding his career as a surgeon and his role in helping family members navigate their own end-of-life decisions. Much of Gawande’s argument rests on the premise that while end-of-life care in the American healthcare system is heroic and equipped with the best possible advancements in medicine, it too often fails the patients it is supposed to help. A large part of Being Mortal focuses on the doctor-patient relationship (especially in the context of shared-decision making) and how we often fail to recognize the things that are most important for our elderly in their …show more content…
Such decisions often come at a great cost to the healthcare system, and at a greater emotional, psychological, and social cost to the patients and families of these patients who are receiving such treatments. Gawande’s book is very pertinent to the present day and has by many accounts sparked a national discussion on end-of-life care and how we treat our elderly. With elderly people accounting for a greater proportion of the American populace and as people start living even longer than they do now, end-of-life care will become and remain a major issue faced by doctors, patients, their families, and the healthcare system. Additionally, with our greater focus on improving patient outcomes while getting the most value for our healthcare dollars, end-of-life care is a major area that healthcare systems and hospitals will focus on, as it accounts for a large portion of their budget. As a response to the need to take care of our aging population, hospice care and palliative medicine are some of the newer specialties in the medical field that have been increasing in popularity and more research needs to be focused in these areas to better understand how to improve patient outcomes. …show more content…
Many of his suggestions provided revolve around training doctors to better assist patients in end-of-life care decisions and to ask pertinent questions and have frank discussions on the matter that encompass more than just medical care, which is what much of the literature provides. However, while many of these suggestions can be implemented, one relevant question is whether healthcare providers, when faced with these critical junctures, always have the time to do so, especially if it is a time-sensitive intervention that requires quick thinking. This may be why Gawande advocates for planning beforehand with the family/patient regarding their desires for end-of-life care, so that if this critical juncture is reached, the best decision is made that accords with the wishes of the
The Dying of the Light is an article by Dr. Craig Bowron that captures the controversy surrounding the role of medication in prolonging life. The author describes that many medical advancements have become a burden to particularly elderly patients who in most instances are ready to embrace the reality of death. Dr. Bowron believes that dying in these modern times has become a tiring and unnatural process. “Everyone wants to grow old and die in his or her sleep, but the truth is most of us will die in pieces,” Bowron notes (Bowron). The article does not advocate for euthanasia or the management of health care costs due to terminal or chronic illness. Bowron faults humanity for not embracing life and death with dignity as it was in the past. He blames the emergence of modern medical advances and democracy as the sole reason why everyone is pursuing immortality or prolonging of life rather than embracing the natural course of things. The article is very articulate and comes out rather persuasive to its target audience that happens to be health-conscious. Craig Bowron uses effective rhetorical strategies such as logos, ethos, and pathos to pass on his message. The article’s credibility is impeccable due to the author’s authority in health matters as he is a hospital-based internist. A better placed individual to dissect this issue by analyzing his experiences in the healthcare profession. The article incorporates a passionate delivery that appeals to the readers’ hopes, opinions, and imagination.
The flow and organization of the topics are structured chronologically and easy for readers to have a clear depiction of the progression of the book. He explains and elaborates his ideas and assumptions on struggles with morality, through real voices of patients and his own personal encounter. The first few topics were lighthearted, more on procedural terms such as the demographics of care in the United States and India and the evolution of care. This heightens to themes that are close to one’s heart as he uncovers the relationship amongst medicine, patient, and the family. It also deliberates on the concerns after medicine becomes impotent and society is ill-equipped for the aging population, which highlight the decisions and conversations one should or might have pertaining to death. He makes
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
It is important that patients and family members understand the conditions under which the patient is suffering from. People have an obligation of preparing themselves for end of live. This can be done by writing a will or an Advance Directive to guide the medical personnel and family members on what the patient wants. It can also be done by assigning a medical care proxy to decide on the patients behalf (Groopman and Hartzband, 2011). Medical personnel need to consider the patients wish and act as per the law when deciding on end-life options. Most of the decisions made by terminally ill patients are biased and compromised.
The medical field is designed to save lives and this article “No Risky Chances,” by Author Atul Gawande’s published in the online magazine Slate, reminds medical professionals one very important thing that there is no risky chances my determining treatment options, professionals need to consider options, professionals need to consider options, professionals need to consider options that are aligned with the patients personal choice which can range from maintaining life by any means necessary to continued comfort until death. Either way it is important for medical staff to be trained not only in saving life’s but also in preparing for patient death.
In the book Being Mortal by Dr. Atul Gawande, he discusses the many grievous trials people face near the end of life. Gawande uses the many experiences that he has had as a doctor and the experiences in his own family to give insight into the good and bad end of life decisions. Reading all of Gawande’s experiences has made me realize the large amount of illness and death I have faced in the last 5 years and helped me to reflect on the outcomes of those events and some of the dilemmas faced by my family. From nursing homes to old age to even terminal cancer in those who are not elderly, all of these topics were extensively covered by Gawande and have been a part of my everyday life.
While the majority of the book critiques the healthcare system, Chapter 13 focuses more on key actions and personality traits that help Dr. Stone relate to patients. Although this noteworthy, compassionate physician attempts to develop an understanding of his patients’ values and goals, he still fails Mrs. Jackson by trying to retain cultural competency by tiptoeing around end-of-life decisions. Conversations about feeding tube placement and DNR orders could have minimized Mrs. Jackson’s unnecessary
The institutionalization of older adults, and human nature of seeking help to prolong life through medical advancement is definitely revolutionizing the traditional deathbed scene. In these scenarios, the healthcare professionals such as doctors and nurses in hospitals, nursing homes, and assisted livings are
A person can read through textbooks, medical journals and any source online, yet will struggle to find a clear definition of what constitutes a “good” death for a patient. This is because the definition of a “good” death will vary from one individual to the next. The Institute of Medicine defined a “good” death in 1997 as one that is “free from avoidable distress and suffering for patients, families, and caregivers; in general accord with patients' families' wishes; and reasonably consistent with clinical, cultural, and ethical standards” (Field 12). The importance is focused on the patient and patient’s family, while also satisfying all medical procedures and inclinations. Using this definition and three sources, Harold Brodkey’s This Wild Darkness, Sharon Kaufman’s And A Time to Die, and Edwidge Danticat’s Brother I’m Dying, it is clear that there are four main factors that constitute a “good” death. These four factors are a control of symptoms, a good relationship with healthcare professionals, a proper preparation and acceptance for death, and an opportunity for closure or sense of completion of the patient’s life.
As illustrated with what happen to Meredith Snedeker with her mother given $40,000 worth of care in her last two months of life and not one of her 25 doctors sat down with her mom and her family and discussed how she wanted to die. One of the possible solutions is having a POLST form set in place with the provider already so that when day comes there is no such miss communication and so on going on. Other things can include having a durable power of attorney and living will set in place. We are not immortals, our lives are not guaranteed and even thought we do not like thinking of the idea that one day we not here, we need to have things like this implemented so that there is no so much burden and suffering at the
End of life care is an important aspect to the health care field. According to the 60 minutes video, the U.S spends around 55 million dollars yearly to provide end of life services to its citizens. Many citizens may feel that the money spent is not being used in the most cost effective way. The U.S use the tax payers and Medicare money to pay for end of care services. Funds that are considered to be a waste in end of life care could be useful in other areas; such as research, finding cures, and continuing advancements in medicine. Another reason citizens may feel the money is not being used in the best way, because a lot of services do not actually save a patients like but just prolong it instead. While prolonging a patient’s life more harm
Palliative care encompasses advanced care planning, legal issues, and ethical decisions which help ensure that the patient maintains their autonomy (Buttaro, Trybulski, Bailey & Sandberg-Cook, 2016). The problem of advanced planning should be discussed with every adult patient with the first exam and then yearly. (Buttaro et al., 2016). Knowing what the patient’s wishes are and having affairs in order is important for every family to have a plan for when the time comes. The Terri Schiavo court battle that brought patients’ rights for an end of life, palliative care and persistent vegetative states and how life and death are determined (Caplan, 2015). There is no standard to how the end of life decisions is made and living wills, and advance directives are not common place for everyone (Caplan, 2015). Palliative care can offer the patient and their family an improved experience in end of life care with patient-centered care (Buttaro et al., 2016). The beginning is understanding what the patient's wishes, which is best achieved with the patient before any disease processes make the patient unable to participate (Buttaro et al., 2016) are.
In Stephen R Connor’s article “Development of Hospice ad Palliative Care in the United States,” Connor reviews the history and growth of hospice and palliative care in the U.S., the Medicare benefit’s relation to hospice, challenges that these end-of-life care services are facing, and strategies to improve the quality of hospice and palliative care.
Life is a blessing; therefore, people should cherish and preserve it as much as possible. Patients in critical situations such as dealing with a terminal illness should be able to decide whether they want to end their lives or to have a physician do it for them. An arguable debate is whether euthanasia and physician-assisted suicide should be legal in many parts of the world. The question has grown and raised concerns: should physician and medical experts end the life of a patient who wills it? Euthanasia and physician-assisted suicide should become legal in the United States and other areas of the world because patients should not have to live life with an unbearable pain and suffer the whole time through it.
Some however are not fully informed of their situation. Doctors and family members can sometimes be reluctant to face the needs of palliative patients. Health care workers sometimes find it difficult to discuss end of life care (Cotterell, 2008). Health care workers find it difficult to spell out that there are no other options for patients who are near death. Many of them want to be fully informed of their prognosis so that they can make arrangements and choose what is best for them. Family members and health care workers deprive them of this right when they do not fully inform them of their situation (Cotterell,