Taking Responsibilty

It is the American way to defend “freedom” for anything and freedom to choose whether or not to do advanced directives is no different.  This is demonstrated by the fact that two thirds of all people do not have a “living will” (see statistics in America as stated in the Jacoby’s article called [Taking Responsibility for Death ]).  Patients are reluctant to make these major decisions for many reasons including political, religious, not understanding medical procedures. Sometimes, the patient simply does not want to face their own mortality.  Americans should take responsibility to make their end of life wishes known.  Advanced directives should be seriously considered much before The Patient Self-Determination Act is enforced upon entering a hospital.  In many cases, a patient’s indecision can result in financial or emotional disasters for loved ones left behind.  If advanced directives are made while the person is alert, alive, and coherent, then loved ones will be eased from some burden.

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A family member may accept being a health care proxy.  If a person agrees to this, that person should do exactly what the incapacitated person would have wanted as though she was capable of making the decision himself/herself.  It is important the proxy clearly understands the dying person’s wishes to the best of his/her ability.  If the dying person never appointed a proxy, the surrogate must act according to his/her best knowledge of what the other person wanted –even when it was never explicitly stated.  This includes acting within the legal means of the law.

In many cases, a patient will never be as familiar with medicine as their doctor considering how extensively the physician has been trained and educated.  There are some traditional areas that advanced directives concentrate on, though, which may guide people through the decision process.

  • The possible positive and negative outcomes of procedures including cardiopulmonary resuscitation, feeding tubes, ventilators, and dialysis
  • Questions about pain and comfort
  • The organ donation procedure
  • The use of antibiotics which may prevent death by natural causes
  •  Do not resuscitate and the possibility of possible negative outcomes such as persistent vegetative state, locked in etc

The patient should also feel confident that his/her wishes will be upheld in the event of sudden catastrophe such as an accident.  At the end of this discussion, the person should have confidence the doctors will be forthright and honest about futility analysis.

The patient and family should clearly understand any decision that may affect their own body.  They should indeed question anything they do not understand – at any time.  This may include why a medicine is being given; what are the side effects; is medicine necessary; is it recommended; will it prolong death;   People must communicate openly with the doctor or else we limit our options and may not be comfortable with our decisions.

Letting Go Near The End

                The medical field should offer the dying person a “good” death.  Since people are individually unique, this “good” death is relative.  The patient centered approach is best.  This approach considers the patient’s interests when making healthcare decisions.  It is contrary to the physician centered approach where decisions are made without patient contribution.  The dying person should have the option of changing their mind about anything, at any time.  For some, it may mean dying in the comfort of your home surrounded by family but for others dying in a hospital with twenty four hour care -hence the term “dying with dignity”.   No matter where the death takes place, an interdisciplinary approach is necessary to understand and satisfy the dying person’s unique needs.

            The medical field should encourage the person to have advanced directives.  Any questions should be answered by medical professionals.  Decisions cannot be made without specific, honest and professional advice.  In the reading, we learned it is probably less painful to be hungry than to have a protruded abdomen.  So, depending on the circumstances, we may decide to forgo food.

                The doctor (unlike Monopoli’s) should make known to the dying person their disease state.  This honesty will allow time to be budgeted for the social and emotional closure the person needs.   These needs vary.  Some people will want formal goodbyes and some will be happy knowing that they are remembered. 

A small party can be assembled to tell the person how much they are loved and will be remembered.  The medical community must yield private time to allow these social and psychological finalities.

            Another area the medical community needs to address is keeping the dying physically comfortable.  Foremost, the doctor should alleviate any suffering by prescribing medication.  An aide may offer comfort by turning a fan on or ensuring there are no bed sores forming.  A volunteer can lightly massage aching hands or feet.  A counselor can help the dying who become depressed or anxious over family strive arising from the death.   The medical field must become part of a team.

            To conclude, a “good” death is characterized by an interdisciplinary approach in which the dying person is allowed to make decisions about their own end of life choices.  The medical personnel should make the person aware of their end of life choices and the progression of the illness so that the person can make wise decisions.  The doctor should always give honest opinions and help alleviate pain.  The person should be allowed to have quality time with their lifelong connections and say their goodbyes.

The team should be able to connect the person to community professionals for spiritual closure, for mental health services, and for taking care of any unfinished business.  And, last, it is my opinion that life should not be prolonged beyond futility.  Still, in the context of this reading, the decision should always be that of the dying whose wishes are most important. 

Let’s talk about dying

So, I just randomly stumbled across this TED talk video during my casual stroll across the interweb and it really caught my attention. Mr. Peter Saul touches on how a majority of people “deny” death and are unprepared for an end-of-life event. He also goes into some research he had done with end of life patients in which the patients were asked what they wanted before death. A lot of what he was lecturing arose interesting questions that a majority of us don’t ask ourselves or others like, “Who would speak my wishes if I was incapacitated” or “Do you have a plan for your own or a family members death”; all very prominent questions that a majority of people disregard.

An interesting topic that I took from the lecture was the advertisement of life and life promoting quotes and how they can pertain to death. I believe that by promoting our knowledge of life and death synonymously in our society today, it could eventually lead those who fear, deny, or are unaware of death towards the acceptance of our dying process.

Just a little brain food for all my fellow bloggers! I hope you enjoyed it and don’t be scared to reply, new perspectives and insights are always welcome!