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Case study end of life decisions
End of life decision making
End of life decision making
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Although dying is a relevant topic for everyone, it is often avoided. However, many areas of death should be openly discussed. Dying is emotionally experienced in a similar way by many people. Kübler-Ross developed five stages of emotion that individuals who are dying experience (Berger, 2014, p. 583). First the individuals experiences denial. They then go through a period of anger, followed by bargaining, depression, and lastly acceptance. You may find yourself somewhere within these stages as well. It’s a normal aspect of dying. Additionally, you should make sure to come to a decision about the care you wish to receive at your death, before you become unable to make such decisions about your death. These decisions can be thoroughly and
clearly stated in an advance directive (Berger, 2014, p. 590). This document may contain a living will, a signed consent for Do Not Resuscitate (DNR), and information recognizing your healthcare proxy. A living will clarifies what intervention, or lack of intervention, you wish to have (Berger, 2014, p. 590). This is helpful for reference if you are ever unconscious or in any way incapable of communicating or establishing your wishes about your death. A DNR is a “written order from a physician (sometimes initiated by a patient's advance directive or by a health care proxy's request) that no attempt should be made to revive a patient if he or she suffers cardiac or respiratory arrest” (Berger, 2014, p. 587). You should also decide on a health proxy who can make decisions for you if you are incapable (Berger, 2014, p. 590). Having a prepared advance directive will put less pressure on family and medical staff in making decisions for you.
Mourning usually occurs as a response to loss of relationship with the person, people or even animals with whom you are attached to, such as death of a loved one, terminal illness, loss of your pets and animals. There are five stages of the normal grieving process: denial or isolation, anger, bargaining, depression, and acceptance; the grieving process varies on the individual basis and may not necessarily follow the sequences as well as a certain time frame (Axelrod, 2015). He further added that it is absolutely wrong to bury his own son who was supposed to bury his own father (Wolterstorff, 1987). Anger is a natural process directed toward the loved ones who are dying or in the dying process.
In 1969, Elisabeth Kübler-Ross opened a dialogue of debate about death and dying. She accomplished this with her ground breaking book “On Death and Dying.” In 1993, another physician by the name of Sherwin Nuland, continued the dialogue with his popular book “How We Die- Reflections on Life’s Final Chapter.” A comparison of chapter one, On the Fear of Death, from Kübler-Ross’s book, and chapter seven, Accidents, Suicide, and Euthanasia, of Nuland’s book, shows that both Kübler-Ross and Nuland argue for control over the circumstances surrounding a patient’s death. However, while Kübler-Ross advocates for strong patient control, Nuland emphasizes the need for physician and society control.
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.
Dealing with someone dying is not something that is going to be fun or enjoyable. Death comes to everyone, none of us can duck and dodge it. Death of natural causes is not something that can be controlled by anyone, but it is important for people to be with those that are dying. When someone you know is dying, whether they are friends or family it’s very important for them to feel loved and not alone. It is also important that the opinions and thoughts of the patient be taken into consideration because they are going through something that no one can say they relate to. In dealing with death, there are many emotions that are felt by the sick patient and their friends and family. In A Very Easy Death
Death and Grieving Imagine that the person you love most in the world dies. How would you cope with the loss? Death and grieving is an agonizing and inevitable part of life. No one is immune from death’s insidious and frigid grip. Individuals vary in their emotional reactions to loss.
Terminally ill patients deserve the right to have a dignified death. These patients should not be forced to suffer and be in agony their lasting days. The terminally ill should have this choice, because it is the only way to end their excruciating pain. These patients don’t have
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.
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
Another reason a patient may opt to euthanasia is to die with dignity. The patient, fully aware of the state he or she is in, should be able choose to die in all their senses as opposed to through natural course. A patient with an enlarged brain tumor can choose to die respectively, instead of attempting a risky surgery that could leave the patient in a worse condition then before the operation, possibly brain-dead. Or a patient with early signs of Dementia or Alzheimer’s disease may wish to be granted euthanization before their disease progresses and causes detrimental loss of sentimental memories. Ultimately it should be the patient’s choice to undergo a risky surgery or bite the bullet, and laws prohibiting euthanasia should not limit the patient’s options.
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...
Today, most states have some laws that allow patients to make informed decisions about how they wish to die. Almost every state allows one to have a living will. This simply states that if one is surviving via ...
Death is part of the circle of life and it's the end of your time on earth; the end of your time with your family and loved ones. Nobody wants to die, leaving their family and missing the good times your loved ones will have once you pass on. In the Mercury Reader, Elisabeth Kübler-Ross “On the Fear of Death” and Joan Didion “Afterlife” from The Year of Magical Thinking” both share common theses on death and grieving. Didion and Kübler-Ross both explain grieving and dealing with death. Steve Jobs commencement speech for Stanford’s graduation ceremony and through personal experience jumps further into death and how I feel about it. Your time is on earth is limited one day you will die and there are many ways of grieving at the death of a loved one. I believe that the fear of death and the death of a loved one will hold you back from living your own life and the fear of your own death is selfish.
The stages of death are known to be a process of mourning that is experienced by individuals from all phases of life. This mourning ensues from an individual’s own death or the death of a loved one. Dr. Elisabeth Kubler-Ross dedicated much of her career to studying this dying process and in turn created the five stages of death. The five stages are; denial, anger, bargaining, depression and acceptance. These stages may not occur in sequence and sometimes may intersect with one another (Axelrod, 2006). The reality of death many times causes a feeling of denial; this is known as the first stage. In this stage, people have many emotions and have a tendency to hide from reality. This reaction is momentary, but should not be rushed. The patient or loved one needs time to adjust to the awaiting death. This adjustment helps bring them through to the next stage; anger. Anger is a common feeling and many times routes from a feeling of not being ready. This emotion may be directed toward God, strangers, friends, family or even healthcare professionals (Purcell, 2006). In some cases, it can be targeted...
Death is a personal experience and to ensure loved one’s wishes, there has to be the ‘what if’ conversation. It is natural to talk about the possible end with loved ones after marriage and having children. Living wills are obtained and do not resuscitate orders, thoughts of a possible guardian for the children, life insurance, appointing a health care agent, and any other loose ends that will ensure the well being of the family. A health care agent is someone who the patient designates to make medical decisions, if decisions cannot be made generally. The chosen agent should be a person who knows the wishes on the extent of medical care treatment wanted. The appointed health care agent should be someone who is not afraid to ask questions of the healthcare professionals to get information needed to make decisions and be assertive to ensure that wishes are respected. (Healthcare Agents, n.d.).
Death is the one great certainty in life. Some of us will die in ways out of our control, and most of us will be unaware of the moment of death itself. Still, death and dying well can be approached in a healthy way. Understanding that people differ in how they think about death and dying, and respecting those differences, can promote a peaceful death and a healthy manner of dying.