1 Withholding or Withdrawing Treatments in Hospice Care By Bayo Adejuwon Liberty University Online NURS 519 Fall 2011, D-02 Submitted to: Dr. Susan Tasker December 14, 2011 Abstract The choice to withhold or withdraw treatments from terminally ill patients have always been a difficult one to make and an ethical one to say the least. Should treatments be withheld or withdrawn from a critically-ill patient at the end of life? Patients and families are faced with the decision to withhold or withdraw treatments. The question most people are asking is whether withholding or withdrawing treatment is killing. Are terminally ill patients being helped to live longer at the expense of their comfort and dignity?
Leaving a medical facility against a physician’s advice puts a patient at risk for untreated or incompletely treated medical issues, increases the need for subsequent readmission or visits to emergency departments and increases the risk of mortality. DAMA presents a dilemma not only to the attending physician but to the nursing staff caring for the patient. Ethically and legally, patients do have the right to agree to or retract consent for medical treatment; however the nursing management of DAMA is much more complicated and multi-faceted than the patient’s right to consent or dissent to treatment. Problems occur with the understanding of the different types of self-discharge from emergency departments, as well as how best to document such encounters and ultimately, how to improve upon current nursing
Life and Death Issues in Healthcare A Review of the Case Study HS101 Abstract There are many issues raised by life and death choices in healthcare. Advance directives are a set of directions you give about the healthcare you want if you ever lose the ability to make decisions for yourself. If you have a disease you can choose curative care which is directed at healing or curing the disease or palliative care which involves care that helps relieve the symptoms, but does not cure or treat then disease. When it becomes apparent that a patient is approaching the end of life, or that the patient no longer wants to prolong their life, a decision can be be made to withhold or withdraw treatment. Advance directive laws merely give doctors and others immunity if they follow it, the only reliable strategy is to discuss your values and wishes with your healthcare providers ahead of time to make sure they are clear about what you want.
Factors that can affect own views on death and dying include: past experience of death and dying; familial views/perceptions; religion; culture; role and responsibilities; training and development. How the factors relating to views on death and dying can impact on practice: coping mechanisms; support structures; avoidance; inappropriate approaches/communication skills; competence; support/care needs not met; family and carers not included in service delivery. How attitudes of others may influence an individual’s choices around death and dying e.g. : limited choices/preferences; choices made for them; little involvement; pre-planned; ease of planning; knowledge of local facilities/resources; preferred options. Understand the aims, principles and policies of end of life care The aims and principles of end of life care: choices; priorities; the person is at the centre of planning and delivery; effective communication; efficient and effective multi-disciplinary/inter agency working; carers/family/friends informed as appropriate; carers/family/friends involved in care planning; person centred approach to service delivery; care and support available to any person affected by end of life and death; practitioners are supported to develop their knowledge, skills and attitudes; practitioners take responsibility for continuing professional development.
Also mentioned, is the increased risk of localized hypothermia and risk for infection as wet gauze to the wound can cause vasoconstriction and in theory, also decrease leukocyte mobility and efficiency of phagocytes. Gauze fibers may also be retained in the wound bed further increasing risk of infection. Lastly, the author suggests that the use of wet to dry dressings are not cost effective since they are labor intensive, require secondary dressings to contain exudate, and usually require nursing care within the community. The article closes by saying that further research is needed to fully understand the impact that dressing selection has in wound healing but suggests that practitioners should question the continued use of wet to dry dressings. Currently, Greenville Hospital System’s policy for healing of wounds by second intention is best met with the use of wet to dry dressings.
In this essay we examine the impact of withholding and withdrawal of treatment from a nursing perspective and examine the ethical issues involved. When a cure is absolutely impossible certain life sustaining medical treatments such as cardiopulmonary resuscitation, ventilation, nutrition and hydration, dialysis, transfusions, and antibiotics may have to be withdrawn or withheld (Derse, 2005). Recent media attention on the case of Terri Schiavo has successfully highlighted the ethical, legal and social issues of withdrawing and withholding treatment. Konishi et al (2002) discuss the ethics of withdrawing artificial food and fluid from terminally ill patients bringing in the dilemma on end of life issues and whether life of patients could be ended intentionally by stopping or withdrawing treatment. Withdrawal of food and fluid from terminally ill patients is a growing ethical issue and concerns patients, families, and nurses as well.
Whereas the quality of life is more important for some because when the body has deteriorated so much that death is a benefit (Right to Die, 2010). Without the quality of one’s life; one is merely surviving. Therefore, when the topic of right to die or assisted suicide comes up one tends to think about Dr. Jack Kevorkian, how one would choose to end their life, and one’s religious beliefs. Euthanasia Euthanasia has been practiced for centuries. However, it has recently become a major issue in the twentieth century (Wells, K.R.
The purpose of this paper is to discuss that as a patient’s life deteriorates care is no longer able to improve a patient’s quality of life but their projected outcome is thought to be a continued degeneration. It is further considered to be in the best interest of the patient and their family to terminate active care. Also, ethical issues need to be addressed concerning what is right for the patient and how making decisions on withdrawing care affects nursing. As stated in Hickey and Montgomery (2009) “with the continued growth of technology, it is difficult to determine if the patient ‘truly benefits’ from such advances”. “Truly benefits” will be used to mean the patient will, in time, have an improved quality of life (Hickey and Montgomery, 2009).
For a patient to die in the Intensive Care unit is a very dramatic way to depart from this life. It is not a good idea, to have a patient, tied down, intubated, and to die suffering by way of being connected to machines and other mechanical devices. I would agree that it is more efficient for a physician to manage a patient’s care in the hospital. I find it to be very painful to go through so many test and procedures when one should be receiving comfort care at the end of their days. I do not agree with using human bodies as a way of making money.
It is known that people who are kept artificially living undergo risks and discomfort. These patients, along with their family and their hospital, suffer the consequences of supporting artificial life. The continuing practice of keeping comatose individuals on life support should be eradicated because of the agony that is faced by the patients, families, and hospitals. Life support is a set of therapies for preserving a patient’s life when that patient’s necessary body systems are not properly functioning to maintain life unaided (Gunsch). Life support may begin with basic CPR.