Questions answer 1-2 from each section below.
Where & how
v How do you want to die? Where do you want to die?
v What support is necessary for someone to die at home?
v How do most people in America die?
v What’s the relationship of technology to issues in medical ethics? Discuss the role of experimental treatments and the limits of technology in end-of-life care. What is futile care?
v How would you determine what is “appropriate care”? Is doing nothing ever appropriate? When?
Experiences & Phenomenology & Existentialism
v What experiences have you had with death?
v What is a good death?
v How could death transform our living?
v Describe suffering (to you).
v Discuss what people fear at the end of life. Why is uncertainty so hard to bear, especially at the end of life?
v What constitutes quality of life for you?
v What does it mean to “dehumanize death”? What does it mean to say that “death is natural”? How is death removed from us?
v What should get the attention—the illness or the person. Explain.
Hospice
v What is hospice?
v Is pain good? What is the value of pain? Of pain control?
v Hospice lets the patient be in control. Is that different from standard medical treatment? How? Should it be different?
v More information at: http://www.pbs.org/wgbh/pages/frontline/facing-death/educational-module/support-for-the-dying/
Role of Health Care Providers, Policy, Family, Law
v What is physician-assisted suicide (PSA)? Should it be legal? Is it legal? Where? Under what conditions? What are the arguments against PSA?
v What is the job/duty/calling of a physician? Does PSA fit in there? Other health professionals?
v Do people have a right to die? (Remember that there is a corresponding obligation on the part of others if so).
v Do you have an obligation to care for a family member who is dying? At what cost to yourself?
v What impact do financial pressures have on caring for someone who can't care for himself?
v What is the Americans with Disabilities Act? What is the Family Leave Act? How are these relevant to the debate about PSA?
v Isn't control over the way one dies and important exercise of autonomy? What arguments are there against allowing this free exercise of autonomy?
Point of clarification: DNR = do not resuscitate (it means do not perform cardio-pulmonary resuscitation; do not restart my heart/breathing).
ReplyDeleteMost people in America die in the ICU of a hospital these days, I would like to die pain free at home.
ReplyDeleteThe experience I have had with death was my husband dying in my arms. And what I consider a good death is my husband dealt with the five stages of death and found his peace in the end. He did exactly what he wanted to and die where and how he wanted to . I believe a good death is when a patient can accept their faith and let go of the anger and accept and believe in whatever is in the after world. To be able to die in familiar surroundings with people you love, pain free is in my opinion a comfortable way to go.
Hospice is a provider that helps people deal with the terminal illness and helps out a great deal with families who are not capable of caring for the terminally ill. There are hospice facilities, they provide in home services and they also have hospice units in the hospitals. Hospice was not one of my husbands choices. I believe Hospice does a great job in allowing patients to be in control of choices. That is much different from the standard aggressive measures that hospitals want to take with invasive procedures which amount to discomfort and a burden to patients. I believe it is a wonderful service that has helped many people and I respect the wonderful nurses who are dedicated to this service. I hope it remains one of the medical services that is personal and not a exploring instrument that I feel the hospital can be.
Control over the way one dies is an important exercise of autonomy because the patient has the right to make decisions about their medical care without the influence of a health care provider influencing them. Some of the arguments against allowing patients to freely exercise autonomy, lack of medical knowledge, doctors fear of not performing that one test that might be the cure, aggressive treatments may save a life. When my husband was given two months to live, a doctor I worked with for 8 years was upset because my husband did not want chemo, and his reasoning was that it was not going to improve the quality of his life , the only thing he felt it would do was it was going to keep him alive with a miserable existence and his doctor turn to me very angry and stated " can't you do something about this" what I had learned in nursing school was this, always always respect the patients wishes and accept and respect their choices.
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ReplyDelete1. Most people in America die in hospitals, surprisingly. In fact, a recurring theme I noticed from this video is that the more care patients received, the worse they got. Radiation, bone marrow transplants, organ transplants, complicated operations—are they really worth it? I feel like they often compromise the patient's quality of life and actually end up hurting more than they help. Personally, I would rather spend my last days enjoying life as opposed to rotting in a hospital. With the advances of technology, we are able to keep people alive who would never naturally be able to sustain themselves. This creates a sense of "playing God" when it comes time to decide whether to continue supplying that technology. Does the technology keep their bodily parts functioning? Yes. Can we classify that as life though? I beg to differ. In the end, we are just prolonging something that normally would have ended much sooner, and with a lot less heartache. Of course, one can argue that it is unfair to make this decision without the consent of the patient. Such things exist now as “do not necessitate” forms, which can help alleviate some confusion, but who really knows what they are going to feel in that situation? Any agreement signed is therefore made without full knowledge of what it will entail. These are all difficult questions that really depend on a case-by-case basis.
ReplyDelete2. The technology and the healthcare really just ends up reducing quality of life in many cases, as opposed to improving it (being tube-fed is an obvious downgrade as is having a tracheotomy). The tricky question becomes what care to accept and what care to decline. I support modern healthcare wholeheartedly for its capacity to greatly enhance human life. I also think procedures are performed on patients with the aim to prolong their lives, without considering how quality of life will be affected. I think people suffer when they have an illness and that suffering continues even with healthcare in many cases (perhaps to a lesser degree, and perhaps not). Often, procedures only prolong suffering, leading to a more painful death.
3. Hospice care is specific to people that are dying. It involves special care that focuses on their emotional and physical comfort in the last stage of their life. This focus on the patient and what the patients’ needs are is somewhat different from standard medical treatment in that it acknowledges death and helps the patient prepare for it, whereas hospitals are often so focused on another alternative treatment that will prolong the patient’s life, or something else they can do to keep that patient alive, without considering how the patient’s quality of life will be affected (in some cases). The chief difference seems to be that Hospice acknowledges that death is near, whereas hospitals ignore the subject completely so as to “not hurt anyone’s feelings.” I think this is a big disservice to the patient, in effect not preparing them for the future or caring for their mental state.
4. Do people have a right to die? I think yes. Just as our constitution gives us the right to life, we also have the right to death. Looked at this way, a physician has an obligation to fulfill a patient’s wishes (be that through PSA, or do-not-resuscitate instructions). This actually simplifies things a lot, whereas it becomes much more difficult if a patient is not well enough to dictate their wishes. Given the right to death, we also have a right to decide how that death should occur. For this reason, suicide is not a federal crime. It is merely that person exercising their right to die. This does not mean I support suicide by any means. I think a person’s right to death extends only to circumstances where death is already near, and the person is physically suffering.
1. What’s the relationship of technology to issues in medical ethics? Discuss the role of experimental treatments and the limits of technology in end-of-life care. What is futile care?
ReplyDeleteTechnology has caused many of the currently debated issues in medical ethics because without today’s technology the issues wouldn’t exist. Before respirators, feeding tubes, dialysis machines, etc we could not keep someone alive when all major organ systems failed. When we didn’t know about stem cells, there was no controversy. Ethics is just trying to figure out the appropriate way to use the technology we now have.
Experimental treatments are procedures that have the possibility to help a condition, but have not been performed enough to know the result. If I had tried any existing treatments for a condition and those had failed, I would opt for experimental treatment. The treatment may or may not help me, could easily hurt me since side effects would not be known, but at least I will help all those in the future with this condition. Based on my results, others will know either not to try this treatment or that it is a viable option to continue testing.
Futile care is when no treatments can be offered and all that is being done is simply prolonging a low quality of life. I would consider someone unconscious in the hospital with no chance of recovery and unable to communicate with friends (the examples in the ICU in the video, those in vegetative state) to be receiving futile care.
2. What should get the attention—the illness or the person. Explain.
The illness should get the attention, but the person should understand the treatment they receive for that illness. In my mind, if the person receives the attention then we have doctors who talk about how your week has gone and how the family is doing as if you were friends, and then if an illness arises there is a bias. In some cases, a doctor who is a friend will fight harder and give you more treatments in the hope they will help. In other cases, a doctor will not want to put a friend through the trauma and rigor of risky treatments and opt to just prescribe pain pills and try to believe they are giving their friend, as a person, comfort. If the illness comes first, then a list of treatment options will be drawn up and the person given their choice of how to proceed. The person is still cared for through explanations and respect for their decisions, but each option given is based on the disease. So, in reality, the two can’t be separated.
3. What is hospice?
Hospice is a facility that provides palliative care to terminally ill patients. The focus in hospice is on maintaining comfort by providing relief of symptoms instead of trying to slow or stop disease progression.
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ReplyDelete4. Hospice lets the patient be in control. Is that different from standard medical treatment? How? Should it be different?
The patient is always in control, in a hospital or hospice, in the sense that nothing is ever done without their consent. It is common to feel out of control during standard medical treatment because we don’t always know if major procedures like transplants, transfusions, and chemotherapy are going to accomplish their goal. In hospice, you have accepted that you are not walking back out the doors but want to remain comfortable. Since the outcome is fairly well known, one may feel more in control. When my mom’s mom was in hospice as a result of breast cancer she chose not to the treat, the goal was pain management for comfort. You are allowed to eat what you want and given whatever medicine is needed for symptoms management. Bed sores are also dressed and taken care of. Same was true of the hospice my dad’s dad entered when he chose to stop dialysis. It is generally easier on the family during the last few weeks or days of life since bathroom/hygiene needs are taken care of by trained staff and medicines can be administered even to comatose patients. Hospice is a good option to maintain maximum comfort during your final days.
Hospice is different from medical care, and should be. The goal of medicine is to improve patients’ health by eliminating or controlling disease(s). To enter hospice is to give up fighting the disease and focus on caring for the person and maintaining comfort. It is two different mind sets.
5. What is the job/duty/calling of a physician? Does PSA fit in there? Other health professionals?
The job of a physician is to maintain or restore health through diagnosis and treatment of disease. Physician-assisted suicide does not fit into that definition, but physicians are the only people with enough knowledge of the workings of the human body to be able to end life the most painlessly. Same as any other procedure, however, if it were legal and patient chose assisted suicide a doctor can help them, but is not required to. No doctor performs every type of surgery or treats every organ system. The doctors who are comfortable with respecting a terminal patients’ wishes to die on their own terms could help them commit suicide, a doctor not comfortable with it can recommend someone else to do so.
Minor clarification: physician-assisted suicide should be abbreviated PAS, not PSA. Sorry for the mistake.
ReplyDeleteExcellent commentary, young philosophers!
1. I haven't given much thought on "how I want to die" or where I want to die. I only know what I want to happen after I die. I guess i would want to die painlessly and quickly. I don't think I would want to be at home either because every time my family would go to the room I died in they would remember what happened to me. I want their memories of me to be positive when it comes to my home. I think appropriate care is when doctors do all that is possible to sustain life to the patients expectations. If a patient doesn't want to be put on life support then carrying out these wishes is appropriate care.
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ReplyDelete2. My experience with death are that when I was four I lost my biological father and mother. I was so traumatized that I had to be carried into the church at my mother's funeral. I went kicking and screaming. I don't remember the funeral though. I was placed with my half sister and her husband which became my mother and father, because they raised me. In 2003 my mother passed away. Suffering to me is when someone is on the verge of dying but is still hanging on even though the pain they are enduring is so much that they are suffering. Also suffering is when someone is in pain and are not getting anything to stop or ease the pain.
3. hospice is a home health care agency that gives to the needs of people who are in the end of life stages. They administer pain medications to keep the patient comfortable just before they die and they provide counseling to the patient's and their families. In my opinion pain is not good because it is a sign that something is wrong but pain can have value. I shows doctors where the problem is and it can help them decide where to do tests. Certain pain control can be addictive. If certain drugs are used to control the pain it can have adverse side effects like addiction.
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ReplyDelete4. The right to die. Yes, people have the right to die but I don't think they should have the right to kill themselves. Americans with disabilities act is a protection against discrimination to people with disabilities. It is a legal protection for them. The family leave act is where families can take a leave of absence from work for medical reasons and cannot lose their jobs because of it. This act protects their right to take a leave of absence. How does this apply to PAS? I suppose if a person has a disability and wants to have their doctor give them medicine to die than this act protects that right. As far as the family leave act I can only think that if the person was on a leave of absence and decided to get PAS they would still have life insurance and it would help with funeral expenses because they were still employed when they died. This act would protect them and ensure that they have insurance to cover the cost of a funeral.
1. I would like to die in my own bed sleeping, maybe from a heart attack, stroke, or simply old age. Most Americans die in hospitals. The top cause of death for Americans is heart disease.
ReplyDelete2. A good death includes knowing when death is coming, understanding what can be expected, being able to retain control of what happens, being afforded dignity and privacy, having control over pain relief and other symptom control, having choice and control over where death occurs, having access to information and expertise of whatever kind is necessary, having access to any spiritual or emotional support required, having control over who is present and who shares the end, being able to issue advance directives which ensure wishes are respected, and having time to say goodbye. Suffering is feeling pain or distress over a prolonged period.
3. Hospice is a special concept of care designed to provide comfort and support to patients and their families when a life-limiting illness no longer responds to cure-oriented treatments. Hospice care neither prolongs life nor hastens death. Hospice staff and volunteers offer a specialized knowledge of medical care, including pain management. The goal of hospice care is to improve the quality of a patient's last days by offering comfort and dignity. Hospice deals with the emotional, social and spiritual impact of the disease on the patient and the patient's family and friends.
4. Physician-assisted suicide (PAS) refers to a practice in which a physician provides a competent, terminally ill patient with a prescription for a lethal dose of medication, upon the patient's request, which the patient intends to use to end his or her own life. Physician aid-in-dying is legal in Oregon and Washington, where voter approved initiatives have legalized aid-in-dying under very specific circumstances. In other states, without specific legislative authority, or a court decision, physician aid-in-dying would most likely be considered illegal, and in many states is explicitly illegal. Arguments against PAS include sanctity of life, passive vs. active distinction, potential for abuse, professional integrity, and fallibility of the profession.
-When I think of my own death, I want it to be peaceful. To me, the most calming image is laying in a hammock on the beach where it is warm, and I would like to die from old age. I don't want my family to be sad or overly emotional. When they hear that I have passed, I want them to think happy thoughts because I would have lived my life to the fullest. A beach is a beautiful place; although most people want to die in their own home, the last place I want them to see me is outside when the sun is setting, that way they can remember that I am in a beautiful place and well taken care of.
ReplyDelete-Uncertainty is hard because people rely on the things going on around them to determine their mood. Many are proactive: letting the negatives and positives affect them. Instead of looking at the strengths of the person who has died and celebrating their life, they focus on what the future will be like without them. The goal should be to make sure the spirit of that person never dies by honoring them through the way we live our lives. We feel the need to have sympathy for the loved ones of those who die by feeling sorry for them. Instead, we should empathize with them by trying to understand what they are feeling.
-I didn't like the term "right" to die because it is something that is going to happen to everyone. I do believe that terminally ill patients should have the right to refuse extraordinary treatment. Hospice is a great thing; it allows people to feel comfortable in the comforts of their own home. Although it is hard to think about, finances are a major factor for how someone will live the last part of their life. Some people will never get the chance to have their final wishes granted, and that is just another part of life. With that being said, professionals have come a long way in accommodating patients.
Weirdly enoughy, I have thought about death. I wonder what it feels like, what people on Earth will be thinking, and also questioning what happens after death. I want a peaceful death; perferably in my sleep at home. I want it to be quick and painless. Unfortunately, most people die in hospitals. A good aspect of dying the hospital is that the physicians are able to relieve the patient of any pain if they are experiencing any.
ReplyDeleteI do believe that the dying should receive "appropriate care." However, who decides what is appropriate because every situation is different. For the dying, I think the main issue is pain. I think the healthcare providers should do everything in their nature to relieve the dying of pain. Next comes the issue of rather any treatments would prolong life. The elderly are weak and surgery is very hard on the body. You have to look at the benefits of procedures, but you also have to realize the risk of death because of the procedure.
Luckily enough, I have only had one death in my family. My grandfather had colon cancer. He died fairly fast after the discovery of the cancer. I do not believe he was in pain but it was very sad because his last few weeks he was too drugged to know what was going on around him. I cannot decide rather a good death for myself would be an expected or unexpected one. An expected death would allow for resolution of any unsolved issues in a persons life. However, an unexpected death would be quick and painless. You also would not know it was coming so it would be less emotional stress on the person.
I do believe that death can transform the living. I believe that when a person has someone close to them die that they start to appreciate life more. If everyone was grateful and appreciative, I think death all around would be more peaceful and more accepted.
I do think physician-assisted suicide should be legal. Noone except for the patient know the pain they are experiencing. This pain can be physical or psychological. Maybe the patient hates seeing their family watch them die and just wants to do it. If they are ready then it is only the patients wishes that matter. However, I do believe there should be limits on it. The patient needs to be oriented and it needs to be requested on several different occassions. This battle of patient autonomy and the role of physicians to enhance life will always be a constant battle.