End Of Life Care: A Case Study

End of life care (palliative) was first seen by a physician Dame Cicely Saunders, “who began her work with the terminally ill in 1948 and eventually went on to create the first modern hospice St. Christopher’s Hospice in a residential suburb of London” (History of Hospice Care, 2015). Saunders then introduced the idea of specialized care for the dying to the United States during a 1963 visit with Yale University. After she made the introduction palliative later became the development of hospice care. In today’s society, hospice focuses on, "caring, not curing and, in most cases: care is provided in a patient's home. The care of a patient can also be provided in freestanding hospice centers, hospitals, and nursing homes or other long-term care

facilities. “In the 20th century, the right to health care is well-established, encompassing not only the delivery of basic, clinical services but also an environment that allows good health to flourish”(History of Hospice Care ,2015).
According to Ethics in Palliative Care” in the terms of terminal death patient and sometime even family members may often seek to end his/her life.” Euthanasia is defined as ‘a deliberate intervention undertaken with the express intention of ending life to relieve intractable suffering” (Ethics in Palliative Care). Although there many countries which practices euthanasia and it is legalized in (The Netherlands, Belgium, some states of USA and Australia) (History of hospice care, 2015). However, euthanasia poses an ethical dilemma in palliative care. According to History of Hospice Care it is interesting to note that the spread of palliative care, use of analgesics, and effective prescription of terminal sedation (even in the face of double effect) have reduced the need for euthanasia, in a recent Dutch study. Hence, palliative care should be considered a better legal choice for the medical fraternity and the society.
End-of-life care is both a medical and an ethical challenge. End of life care is an important issue in patients and their family can face several uncertainties. There are many possible outcome that can be seen from death, a good death is typically an example of seen when the patient's goes home to die and they are, surrounded by family members and relatives this is typically what someone would call a good death. As far as possible, home care instead of a hospital or hospice should be explained by the palliative care team.” In places like India, it is one of the home care will be less expensive and a more practical approach to offer palliative care at the “Menanti, Bidhu, 2015).
According to Ethics in Palliative Care “Wherever possible, the patient's preferences should be balanced with palliative care principles”.

Although, “patients have the right to avoid the terminal palliative care patient being subjected to unnecessary tests, hospitalization, intensive monitoring, and resuscitation procedure.” In many countries of the world, do-not-resuscitate (DNR) policy is well founded in end-of-life care” ( Menanti, Bidhu, 2015). Although one the most difficult decisions confronting people at the end of life are those about discontinuing life-extending treatment. Frequently, in the course of caring for a critically ill person, it may become apparent that further intervention will only prolong the dying process and not improve quality of

life.
Decisions to withhold or discontinue treatment are determined by a variety of factors, including judgments of medical futility and the emotional status and coping styles of the family members and the dying person. At that point, additional treatment is often described as futile. The concept of medical futility takes shape in sociocultural and interpersonal contexts, and conflicts about whether a situation is futile may arise for several reasons. Family members may disagree about future treatment or may oppose the physician's recommendation to discontinue life support. The physician may want to continue treatment and be opposed by either the family or other medical professionals.
The legal aspects is an important issue for the health care provide to provide the patient with the human rights by giving the fundamental protections that allow equal participation and individual justice in a society.

It means ‘no one ought to harm another in his life, health, liberty or possessions’. Although many times the legal or ethical issues should not also play a role in the decision to stop or maintain life supports. Issues cause by conditions and disease may alter the mind frame causing the of influence judgments to help alter the pain and suffering that patients may be going through. Ethics in Palliative Care “some people argue that discontinuation of futile care is good for individuals, families, and society”. The article states that “others have countered that costs may be a primary motive behind assessments of futility, which disproportionately discriminates against dying persons with limited resources” (End of Life Issues and Care,

2015).
As a Public Health major my overall viewpoint of End of life care “Palliative care” should an option to those who may need to seek care for advanced stage incurable cancer and other terminal chronic illnesses. Although there different aspects of palliative care such as pain and symptom control, psychosocial care, and end-of-life issues should be managed in an ethical manner. The ethical principles of end of life care to be followed are-autonomy, beneficence, non-maleficence and justice. The palliative care experts and team members should carry out their responsibilities with honesty and dignity to provide the high quality and standards to meet the patient’s needs. Although many of the patient are suffering and incurable condition of disease they still remain the right to be treated with dignity and respect even if it is their decision to end one own life.