Hermiller Research Paper

End-of-life CarePaig HermillerKettering CollegeEveryone has different challenges they must overcome in this life; however, all people must face the reality of death. A common question among older adults is “What is a good death?” (Black & Csikai, 2014, p. 32). There is a great amount of fear surrounding death in American culture. “The aging U.S. population is expected to reach its zenith in 2030, which means a growing number of us will be facing the process of death and its associated difficulties in the immediate decades to come” (Stabile & Grant, 2016, p. 69). An increasing number of individuals express a desire to act upon an intent to end their lives quickly and efforts have been made to progress the end-of-life experience (Black & Csikai, 2014). A longer life is not necessarily a better life. Death is not easy, not for the patient or their family members involved, many of whom are not educated on the choices a person can make when living with a terminal illness. Terminally ill individuals should have the right to choose their own end-of-life decisions when lying ahead is unbearable pain and suffering to an end that is unavoidably coming. “Although many intend to stay in charge at the end of their lives, loss of autonomous decision-making in the latter stages of a deteriorating illness is common,” according to Black & Csikai (2014, p. 31). As a healthcare provider this leaves two choices: to support the patient in their decision to end their lives or to ease the discomfort until it is manageable by using modern medicine. People are facing longer periods in their life of deterioration before death and there has been an increasing amount of dissatisfaction with the dying experience, it is being voiced by people who are terminally ill, caregivers, and health care providers. There are two aspects to address when considering end-of-life decisions: a living will and a DNR order. A living will is the patient’s preference with their end-of-life decisions. It is applied when a patient cannot express their wishes personally. Stated by Black & Csikai (2014), “mounting evidence suggests that the use of written advance directives has not improved the overall dying experience in the Unites States” (p. 33). According to the American Heart Association, “A do not resuscitate (DNR) order is set up before a medical emergency and it allows the patient to choose if they would want resuscitative care, cardiopulmonary resuscitation (CPR), or advanced medical directives in an emergency” (2019, para. 1). A DNR is also referred to as a no code when identifying a patient’s resuscitation status. In order for it to be valid the physician and two witnesses need to sign the documentation. In essence the difference between DNR and a living will is that a DNR order withholds any resuscitative medical care, whereas a living will allows a patient’s prior wishes to be respected on end-of-life care. A living will is an important mechanism for offering guidance to health care providers in areas such as pain control and resuscitative efforts (American Heart Association, 2019).Hospice care specializes in the end-of-life care and their employees work very hard to grant their patient’s wishes, such as a DNR order. Increasing in accessibility over the past decade, hospice care programs represent another way in which a person can plan for end-of-life care. “Hospice care improves the quality of life for individuals and families managing chronic and life-threatening illness through the prevention and relief of suffering by early identification, assessment, and treatment of the multidimensional aspects of pain including not only physical, but psychosocial and spiritual as well” (Black & Csikai, 2014, p. 35). “Hospice teams specialize in symptom management and seek to optimize the quality of life in terminally ill patients, while neither hindering nor hastening the dying process” (Death with dignity, 2019, para. 12). Hospice is often thought of as a place but in reality, it is a type of care that gives patients a more peaceful death. “Hospice care and palliative measures are portrayed as effective in almost all circumstances to relieve pain and distress without resorting to purposefully hastening death,” stated Campbell & Black, (2014, 140). In order for a person to qualify for hospice, a doctor must determine that a person has six months or less to live. They must also deny further restorative treatments. Controlling pain and other symptoms, providing counseling and giving support to the patient and their families, maintaining a certain quality of life, and numerous other services is a couple of the responsibilities that hospice caregivers have. Most people prefer home hospice because it helps people remain in control at the end of their life while dying at home. “Despite evidence that palliative care serves the total needs of persons dying from terminal illnesses and improve outcomes, several qualifications to its use exist […] palliative care is not widely accessible throughout the United States” (Black & Csikai, 2014) (35). Voluntary stopping of eating and drinking (VSED) is another ethical alternative to physician assisted suicide that is legal across the United States. Most people who initiate voluntarily stopping eating and drinking are typically older and have a terminal illness with a short life expectancy. Voluntary stopping of eating and drinking is legal and ethical for nurses and other healthcare providers to participate in because it is seen as a withdrawal of life sustaining means. To voluntarily stop eating and drinking implies the right to refuse all food and liquids, including anything given through a feeding tube. It is a deliberate, self-initiated attempt to hasten death, most commonly because of unbearable suffering. Without any food and liquid for a few days, a person normally becomes weak and fatigued and is likely to be sleeping more. They will ultimately fall into an unconscious state or a deep sleep like coma before dying transpires. At this point the time until death cannot be projected, but depending on the individuals age, illness, and nutritional status, death can occur anywhere from a couple of days to a few weeks. This is because a person can live for a long time without eating, however dehydration speeds up the dying process” not increasing the suffereing because uncomfortableness with subside (Quill, Lee & Nunn, 2000) (). Once the initial feeling of thirst subsides, dying from dehydration is generally not uncomfortable (Wax, An, Koiser, & Quill, 2018). Thirst and dry mouth are the most common symptoms that a patient may experience but it can be controlled by using mouth swabs and lip moisturizer. It has been recorded that:People who begin this process often express a sense of peace that they can finally stop fighting. Some people describe a sense of euphoria or pleasant lightheadedness. There is an analgesic effect caused by dehydration that may explain this response [to being dehydrated.] With dehydration, people often need less pain medication, urinate less, have less vomiting, and breathe more easily due to decreased congestion. (Death with Dignity, 2019, para. 8) One of the advantages in choosing to voluntarily stop eating and drinking is that the person may resume eating and drinking at any time if they change their mind. This end-of-life decision and hospice care are morally accepted, while other methods are more controversial. The most radical way for a person to terminate one’s life is physician-assisted suicide. Physician-assisted suicide for terminally ill patients is a controversial issue, with a widespread list of ethical, legal, and moral concerns. It is commonly defined as providing a competent patient for a prescribtion to end their life. (Brock, 1999). “However, physician-assisted suicide is only possible by states that have these statues, California, Colorado, District of Columbia, Hawaii, Maine, New Jersey, Montana, Oregon, Vermont, and Washington (Death with dignity, 2019). In order to qualify under death with dignity statutes, there is certain criteria that must be met. First, a person must be an adult resident, 18 years or older, of the state in which the statues are in place. They must also be mentally capable and be able to communicate their own healthcare decisions. They must be diagnosed with a terminal illness, confirmed by two physicians. Lastly, the individual must be able to self-administer and ingest the medications required to end their life without any assistance. All of these criteria must be met without any exceptions. “If either physician determines that a person’s judgment is impaired in any way, such as a mental illness, the attending physicians must refer the individual for a psychological or psychiatric evaluation” (Death with Dignity, 2019, para. 8). All of this criterion is known as aid- in-dying laws. The general rule for beginning this process starts with the physician-assisted process requires two oral requests, one written request, a couple of waiting periods, and the above-mentioned criteria. The first step is to make the initial appointment with their physician to express their wishes to obtain the medication for death. The attending physician must confirm that the individual meets all of the eligibility criteria. Palliative care, hospice care, and pain management are options that a physician must inform the patient of as use of alternatives. A consulting physician must authorize the the patient’s mental state. If the patient’s first request is authorized then they must wait for 15 days before they can make the second oral request with another physician. There has be two individuals who must witness the written request, and it cannot be a family member. There is a second waiting period that lasts for 48 hours before the physician can write the prescriptions to aid the patient in dying. The physician will then write the prescription for the patients request. The most common medicine prescribed is a sleeping medication. The medication is normally in powder form and is mixed with a small amount of liquid to make it easier to consume. The patient needs to drink the whole amount in a few minutes for the medication to be effective. Many patients take about 10 minutes to fall asleep and die within 1-3 hours. In a small percent of patients, it may take longer than 1-3 hours to die, but they will sleep comfortably until death arrives (Death with dignity, 2019).However, patient’s still have a choice to continue on with their choices up until they physically take the medication. Even if the patient has the prescriptions written or if the medication is in their hands, the patient can choose to not use the medication. The aid-in-dying law is all about giving choices as a state resident. According to Death with Dignity (2019), “about one third of qualified terminally ill patients decide that they do not want to hasten their death using the prescription. The prescription provides them with peace of mind, knowing if their symptoms get too bad, they can choose to take the medication” (para. 17).Caring over curing represents the direction that healthcare is heading towards, as it is going to be more important to help educate people on the choices a person can make when it comes their own death. As healthcare providers, it is vital to accept other individual’s wishes when dealing with their choice with life or death. Free will and the ability to choose are the foundations of maintaining one’s quality of life and dignity in their final days. Modern medicine has come a long way but there are people who are terminally ill that have inadequate access to resources in healthcare that can aid them with their dying wishes. A common theme between the above-mentioned ways to die is that it is the patients wish to die because their quality of life is poor, they have a desire to die at home, and they wish to have control over the last moments of their lives. Currently, there are patients with terminal illnesses and life-threatening physical debilitations who believe that death is their only option because it is better than the physical or emotional pain and suffering that they are currently experiencing. As a result, the right to die has been slowly paving the way for individuals to legally cause their own deaths. It takes a considerable amount of courage for a person to not only confront their mortality, but to take control of it. ReferencesAmerican Heart Association. (2019). American heart association. Retrieved from https://www.heart.org/Black, K., & Csikai, E. L. (2015). Dying in the age of choice. Journal of Social Work in End-of Life & Palliative Care, 11, 27-49. https://doi.org/10.10180/15524256.2015.1021072Brock, D. W., (1999). A critique of three objections to physician-assisted suicide. Ethics, 109, 519-547. https://doi.org/0014-1704/99/0903-0005Campbell, C. S., & Black, M. A. (2014). Dignity, death, and dilemmas: A study of Washington hospices and physician-assisted death. Journal of Pain and Symptom Management, 47, 137-153. https://doi.org/10.1016/j.jpainsymm.2013.02.024Death with Dignity National Center. (2019). Death with dignity. Retrieved from https://www.deathwithdignity.org/ Stabile, B., & Grant, A. (2016). How do we die? Politics and the Life Sciences: The Journal of the Association for Politics and the Life Sciences, 35, 69-74. https://doi.org/10.1017/pls.2016.12Quill, T. E., Coombs Lee, B., & Nunn, S. (2000). Palliative treatments of last resort: Choosing the least harmful alternative. American College of Physicians-American Society of Internal Medicine, 132, 488-493. https://doi.org/0014-1704/99/0903-0002Wax, J., An, A., Koiser, N., & Quill, T. (2018). Voluntary stopping eating and drinking. The American Geriatrics Society, 66, 441-445. https://doi.org/10.1111/jgs.15200

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