Contemporary Moral Problems
December 15, 2009
End of Life
I would like to start off by answering two questions: “What is a person? and “What is death?” When I started looking up a definition for “person” it amazed me how many different variations there are. I feel that a person is one that is recognized by the law and has rights and duties. A person also has the moral right to make its own life-choices and to live without interference from others. Death is an eternal termination of all vital functions. The website death-and-dying.org says “death is the cessation of the connection between our mind and our body”. I do agree with this statement with the thought that when death occurs our consciousness leaves the body to go on to the next life. Dying is the final portion of the life cycle for all of us here on earth. Providing excellent, humane care to patients near the end of life, when healing means are either no longer possible or, no longer desired by the patient, is an essential part of medicine. For physicians and health care providers to provide excellent care to dying patients and their families, they need expertise as well as compassion. Making excellent care for dying patients regularly available will require improvements in the professional education. There should be added teachings on the life of and the care of a terminal person. The care of the dying patient, like all medical care, should be guided by the values and preferences of the individual patient. Independence and dignity are central issues for many dying patients. Maintaining control and not being a burden can also be relevant concerns. I believe the patient “maintaining control” is the first concern of someone who has been given a terminal diagnosis. Sometimes the hardest part about dying is the effect it has on family and friends. Helping them deal with the pending death also helps the patient find peace and comfort. By maintaining control of medical decisions and helping others deal with the imminent death, helps the patient be at peace with his or her own mortality. As a member of the hospital Ethics Committee, I would like to say, there are many hospitals with poor end-of-life policies or inadequate palliative care training for their physicians. We live in a death denying culture and too often hospital policies cause the dying patients often to suffer needlessly with their pain and symptoms going uncontrolled or the doctors make the decisions on the treatment or care without first consulting the patient or family. I want to introduce programs to make doctors more comfortable caring for the dying, including respecting a patient’s wishes even if the physician does not agree with them. A policy of “patient-centered care” where the doctors consult dying people about their desires and priorities should be put in place. This policy should not allow doctors to contradict a patient’s wishes or make decision on their own, even when they think a bad choice has been made. The doctor should be able to discuss the options and alternatives with the patient but ultimately the patient makes the choice and the doctor follows through with the decision. If the patient is unable to decide for themselves the doctor should defer to someone with legal authority to make the decision on behalf of the patient and then follow this decision. I propose a project that teaches staff to recognize when a patient is within days or hours of death. It then instructs them to follow specific procedures, including counseling patients and families through decisions about end-of-life care. With the goal being to ensure more people spend their final days in comfort and dignity. What I want to see is people who are not experts in palliative care learn the skills and model them so that they become the standard for doctors. “By equipping more physicians with the skills to treat the routine cases, palliative specialists such as Dr. Bhimji say...
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