Ethical and Legal Issues of Death and Dying Essay Sample
This was not easy to put this paper together. Recently my mother- in- law passed away, and her death was devastating to the entire family as well many friends. She was diagnosed with Alzheimer’s and became dependent as she neared the end of life. All anyone of us could do was comfort her with our expression of loves while we tried to comprehend what was taking place. We leaned close, whispered I love you in her ear, and held her hands at all times. Our loved one was dying right before our eyes. As a family we had to adjust to her decline from an active, loving, spirited, wife, mother and grandmother, who loved to dance, to a fragile, helpless, inactive woman who communicated with the family through her touch and her big blue eyes. We gave her our full attention as we made sure she received great medical care during her end of life. As we sit with her, she gave us a sense that she was becoming more comfortable with her passing as if she was trying to soothe our hearts. She passed away and today she is missed so very much. My experience with my mother- in- law has guided my writing. I didn’t share any personal accounts of my experience but I could relate to every part of this paper. What I have shared, is the knowledge I have gained about the importance of being prepared for end of life and making certain that your wishes are carried out.
Historical perspective about death and dying today has gradually changed throughout history. History of death and dying has set forth values, customs and beliefs for many cultures and religion to build on. Throughout history different cultures and religion have continued to form their very own ideas and beliefs about how they want to die. In the late 1800’s most people died in the comfort of their home. Death was common due to living conditions and medical practices. If someone died it was often the result of an infectious disease like “TB or similar illness”. (Barker, R.N., & Foerg) There were no antibiotics or immunization. The expectation of living a long life many years ago after acquiring an infection or a disease was small. Most people would expect no more than comfort care from their family and their physician if they were dying. During the 1900’s to 1950’s science and technology have advanced, improving medical procedures and extending life for those who have acquired infection or disease. The discovery of antibiotics impacted the length of life (Barker, R.N., & Foerg). The care for the dying became more than just comfort care. The direction of caring was also on trying to cure the illness. Taking care of a dying patient extended from the homes into the hospital. Physicians and nurses began to provide more care within the hospital setting.
Issues and challenges affecting the delivery of quality health care given to dying patients are communication, emotional, spiritual beliefs and advance planning. These are also issues that affect the patient, the patient’s family and other support persons. Caring for a patient who is dying is an experience that goes far beyond any knowledge or skill learned in any clinical field. Honest and open communication between patient and caregiver, about the patient preference for care is important for the best possible outcome during the patient’s end of life.
Communication in health care especially for a dying patient can be complex. It’s a process which information and feelings are expressed through verbal and non-verbal interaction. With good communication between the patient, family and healthcare support, it’s easy to assess the patient, understand the patient’s beliefs, and meet the patient’s emotional needs. Good or bad communication in a healthcare setting of any kind can make a patient and family of supporters experience positive or negative, and can make a lasting impression. Positive communication in health care can put a dying patient at ease, with just a few comforting words or gestures.
A lack of positive communication in any health care setting can leave a patient feeling neglected ignored and not valued as a human being. When communication is successful in patient care, the patients, family and caregivers thoughts and ideas that go into the act of caring are effective, and when communication is not successful among the patient, family, and caregiver the thoughts and ideas that are meant, don’t necessarily reflect what is thought causing a disruption in communication, understanding and interaction. Effectively communicating provides accurate, assessment of physical, psychological, spiritual and social dimension of care (Ferrell & Coyle, 2010). Communication is an “essential part” of patient care (Eileene E. Morrison, 2011, p. 255).
Emotional support usually means reassurance and the presence of family, and health care workers to ease the fear of loneliness. Emotional reactions are as individual as physical reactions. A dying person needs great emotional care. The patient’s family travel down the same road as the dying person so including them in on the happenings or what is likely to happen is important. Trying to cope with the loss of a family member is very difficult to do. It’s important for patient and family to work through their feelings and not avoid their emotions. Among the emotional considerations regarding the type of medical care a patient wishes to receive as end of life approaches, are also legal and ethical issues. For example a patient who becomes unable to convey their wishes toward end of life and do not have any legal documentation beforehand expressing their wishes will be faced with these issues as well their family and health care professionals.
The legal and policy issues of end of life care, is not just the concern of health-care professionals, patients and families (Ferrell & Coyle, 2010, p. 1173). It is also a concern of “the government”, and “the public at large” (Ferrell & Coyle, 2010, p. 1173). The federal government’s interest in end of life care has increased. The judicial history is filled with cases, court decisions and opinions that have influenced directly or indirectly the course of end of life care (Ferrell & Coyle, 2010, p. 1173). The courts are often used to resolve conflicts among patient family and healthcare facility. The legal system is known as an adversarial system (Ferrell & Coyle, 2010, p. 1174). It’s when two advocates, who represent either side of a dispute, present their argument to a judge for a decision. This dispute can emerge between patient and family or family and the hospital care facility. The adversarial nature of the judicial system magnifies the intensity and painfulness of very complex emotional dilemmas (Ferrell & Coyle, 2010, p. 1174). The judicial system has had to deal with many issues in regards to end-of-life care including “decisional authority, refusal of therapy, and physician assisted suicide” (Ferrell & Coyle, 2010, p. 1174). Although each of these decisions deal with individually distinct legal circumstances these cases like many other cases draw attention and concern about end-of-life care.
One of the most important case in recent years is the case of Terri Schiavo case which attracted worldwide attention and drawing interest of the media public and churches was played out in “the judicial system as well as the legislative system” in regards to end-of-life care (Ferrell & Coyle, 2010, p. 1174). Seventeen years ago her heart stopped, and her brain was deprived of oxygen, which resulted in permanent brain damage. The Terri Schiavo case was a struggle involving prolonged life support that lasted from 1998 to 2005 (CBC News, 2005). Terri Schiavo was able to breathe on her own while receiving artificial nutrition and hydration. The most important issues concerning medical decision making here is that no one knew exactly what her wishes were if she was unable to make any medical decisions for herself. Since Terri Schiavo did not have any of her wishes documented her husband became her spokesperson.
The argument over whether to keep Terri Schiavo alive with a feeding tube heightened the interest of the nation, with President Bush and Congress weighing in on the side of her parents. The courts, politicians and congress became involved with this case because of the conflict of interest between Terri Schiavo husband and her parents. Both sides had strong beliefs about her right to live or die. If an advanced directive was created prior to a person becoming incapacitated then all related decisions are made by that person’s family. This is where the adversity among family members occurs. The family argues over who is the best person to make the best the decision about end of life care for their loved one. The Terri Schiavo case focused national attention on the importance of advanced directives.
The legislative initiatives have influenced end of life issues as well. “One of the most significant acts of legislation is the Patient Self-Determination Act which provides protection for the decisional authority of individuals (Ferrell & Coyle, 2010, p. 1175)”. It was “the first federal act” that required medical providers to “acknowledge the legal rights of the recipients of care to make decisions about their healthcare” (Ferrell & Coyle, 2010, p. 1175). This exceptionally great act provided a driving force for legislative movement at a state level, and also the widespread acceptance of advanced directives.
Ethical issues that relate to or effect end of life care can greatly impact the health care provided to a patient. The following are examples of ethical issues that are addressed with regard to end of life care.
When the patient and family, have prior information about the patients probable course of health, or near the end of life, preparing your advanced directive for the specific purpose of carrying out your wishes is comforting. Advance directives are important in case the patient becomes incapable of making medical decisions for themselves. Advance directives provide the hospital, staff and family with the necessary direction to authorize the use or withdrawal of medical care. According to the Federal Patient Self Determination Act advanced directives are “an individual’s right under State Law to make decisions concerning such medical care, including the right to accept or refuse medical or surgical treatment” and such directives will ensure that the patient wishes are followed to either conduct procedures to save your life or no procedures to allow you to pass on (www.legalhelpmate.com/health-care-directive-patient -act.aspx). Advanced directives are important in providing quality patient healthcare, without it someone else is appointed to take care of medical care decision for you like the next of kin.
The patient, the family as well as healthcare providers are faced with ethical dilemmas about end of life care as well as many other medical choices. Questions about any part of medical care during end of life, can arise and include withdraw treatment, CPR, nutrition, or sedation to name a few. The choice to decide on the type of medical treatment rendered at end of life is the patients. Patients vary in the amount of involvement it takes to make end of life decisions but it is still the patient’s call to make. The patient and family can be satisfied that everything was done if the decisions are made by the patient. When it comes down to decision making most patients would like to be informed as well involved. According to the Journal of American Academy of Family Physicians (AAFP), the following are advance directives that can be used to convey the patient’s wishes about end of life care.
A durable power of attorney is a legal document that allows you to choose someone you trust, like a family member or friend to make health care decisions if you lose the ability to make them yourself. The document would go into effect after the patient becomes incapable of making health care decision.
A proxy is used to name a person who will represent you in making health care decisions. For example a friend, family member or lawyer is a type of proxy. The proxy carries out your wishes. The proxy ability to make a decision can be taken away by the court if the court feels the proxy is not carrying out the patient’s wishes.
A living will is a legal document that clearly states your beliefs and wishes regarding the type of care you wish to receive in the event you are not able to communicate your wishes. It informs your family and doctor what type of treatment you wish to have once you are near the end of your life or you are unable to express your wishes. It also allows a patient to refuse treatment.
A Do Not Resuscitate or DNR is a legal document that respects the wishes of the patient to not have cardiopulmonary resuscitation (CPR) if the patient’s heart stops beating or the patients stop breathing. It is a form that is commonly discussed with a physician.
Death and dying is a tough subject. Having to loose someone you love or having to know you are near death can make the process scary. Everyone experiences death and every experience is different. It’s important to make responsible preparations with family and friends so that your wishes or your family member’s wishes are met. The decisions you make are personnel and they are based on your beliefs. If you talk about it with your family it will help to relieve them from thinking about what you would have liked. It’s a very difficult conversation to have but it’s a conversation that can strengthen you relationship with your family and healthcare team. The maximum patient empowerment is to be prepared.
Barker, R.N., & Foerg, Mary CSW. (n.d.). In Mendez (Ed.), Historical Perspectives of Dying and Death in America [Training Manual]. Retrieved November 14, 2012, from Historical Perspectives of Dying and Death Web site: www.eperc.mcw.edu/…/HistoricalPerspectivesofDyingScript.pdf CBC News. (2005, March 31). Terri Schiavo [Fact Sheet]. Retrieved November 14, 2012, CBC News Web site: www.cbc.ca/news/background/schiavo Eileene E. Morrison. (2011). Ethics in Health Administration (2nd ed.) [A Practical Approach for Decision Makers]. Sudbury, MA: Jones and Bartlett. Ferrell, & Coyle, Nessa. (2010). Palliative Nursing (3rd ed.). New York: Oxford University.