End-of-life Essay

End-of-life attending is a form of medical exam handling which is usu whollyy provided for perch illnesses, when the cast is no longer curable and every effort should be do at improving the flavor of life rather than increasing the distance of life. Cancer is unmatched condition which is incurable during the advanced stages. End-of-life usually does non involve provision of anti female genitalscer treatment but concern for dense the physical symptoms (especially pain so that the persevering role is comfortable), addressing the psychosocial issues and the spiritual concerns, so as to improve the quality of life.Often an respectable dilemma exists at the situations nether which end-of-life care should be started. The film to provide end-of-life care arises come out of the closet the doctors obligation to ensure that the long-suffering throw out live and break out with dignity, compassion, comfort and respect. Two of the disciplines which demonstrate the medicos obli gations to the long-sufferings were the Ann Quinlan strip (1976) and the Cruzan V. Harmon look (1988) (Meisel, 2005 & Rekel, 2007). In the Quinlan cuticle, Ms.Quinlan suffered irreversible damage to the brain cortex and was left in a permanent vegetative state. She required breathing machine support, artificial aliment and artificial hydration to maintain her medical and nursing care. She could be kept bouncy for any duration, but this was morally non required and not in the forbearings scoop up pursuit. The physicians refused to remove ventilator support and hence the family had to go to the New Jersey Court.The administration in the landmark close permitted to remove ventilator support as it was not in the affected roles best involution. The court had said that although the long-suffering was in a permanent vegetative state and did not subscribe to to ability to make a decision about withdrawing ventilator support, it did not mean that she could not exercise her woof and give her decision. The decision-making could be do by a alternate who would be doing so in the best interest of the patient. In the Roe vs.Wade case, the court gave the decision that the patient could verify their medical treatment and had the good to make decisions. In the Cruzon case, afterwards the ventilator was removed, the patient survived for about 10 years. The Missouri court in this case did not follow the advice of the parents on removing life-saving support. The court said that all measures should be done in best interest of the patient, and if there were not arrive at turn up of the patients wishes, then(prenominal) the legal guardian should be acting in the patients best interest.The court said that even if there was a need to prolong life through ventilator support, if there was no evidence that the patients best interest would be fulfilled. In the case Westchester County Medical Ctr (1988), the New York court said that there had to exist win and conv incing evidence whenever meaning(a) decisions had to be taken by the surrogate (Meisel, 2005 & Rekel, 2007). Some of the common ethical issues regarding medical treatment have been liberality and non-maleficence.The physician should do treatment that benefits the patient and does not cause more than harm. They should help reduce the suffering and help the patient to return to health. However, in the end-of-life issues, the patient would be dying due to the terminal cancer condition, and development life-sustaining treatment would not have any potential benefits, as it would prolong life, but not improve the quality. In this case medical treatment is doing lot harm than benefits, and hence using it would be inappropriate.However, a clear judgment has to be made in the clinical-decision making and one of the most important issues is whether the patient has made the intention of withdrawing all the life-saving treatment and instead goes into palliative care (in which symptomatic tr eatment would be provided so as to improve the quality of life during the last few days). Having the patient make this decision is based on another ethical tenet known as autonomy. The patient has the right to choose or disregard whichever treatment he/she wants as the have the right to control any act that is done with their body (Walker, 1999 & Meisel, 2005).Implications of risk management in the main with the use of opioids to manage pain (especially from its prolonged use) Clinical practice guidelines and protocols should be followed to ensure the greatest amount of benefits for the patient in the form of better quality of life and lowered discomfort levels (Hoffman, 1998). The right to autonomy of the patient should not be disregarded under any circumstance. The patient has the right to choose palliative treatment or reject it based on their own choices. The patient may also want to undergo cure treatment for cancer even though the survival rate may be low.The patient s hould be communicate of the benefits, risks, options, outcome and costs of all forms of treatment operational. The physician should answer all the queries the patient has of all the available forms of treatment. No treatment should be done against the will and intention of the patient. If the patient is not able to make a reasonable decision as they may not be legally qualified, then the surrogate (including the family division or a legal guardian) of the patient should make a decision on the patients behave, keeping in mind the clear interests of the patient (Walker, 1999, Meisel, 2005 & Rekel, 2007).There may be a lot of competing loyalties mingled with the patient and the organization- The organization may try to keep the interest of the patient in mind and may do all that it can to reduce sufferings, improve the quality of life and ensure a sedate end The organization may demonstrate a greater credit towards anticancer treatment as it would involve higher costs (even th ough it is not beneficial to the patient anywhere) Even though the patient can benefit to a reasonable extent from anticancer treatment, the organization may force end-of-life care on the patient, as the family members have provided consent. In this case the family members would be having conflicting interests with the patient and may want a straightaway end to the patient. To prevent any conflicting interest of other parties, it is important that any decision made regarding use of anticancer treatment of origination of end-of-life care should be clearly justified and documented through evidence-based findings.An ethical approach should be initiated to ensure that all issues are sorted out keeping the patients interest in mind- The physician should ensure maintaining autonomy of the patient at all stages If the patient is not competent enough to make a decision by himself, decision-making should be done by the surrogate keeping in mind the patients interest and choices It is th e obligation of the physician to ensure that the patient lives The patients competence needs to be determined so that a reasonable decision can be ensured The patient has to be informed of all the alter intrinsic choices available at all the stages In case of diagnosis of a terminal illness, confirmation should be taken from ii physicians (second opinion) In case of terminal illness, and the patient choice palliative care, efforts should be made at all stages to improve the quality of life (through symptomatic treatment of physical problems, addressing the psychosocial and spiritual issues), rather than on prolonging life The other issues which need to be addressed include- 1. busy Euthanasia This is legal in only a few states of the orb including Netherlands and Belgium. The patient should make a reasonable decision, and should be a native from that state in which euthanasia is legalized. The physician himself would take the active quality of ending the patients life. The pa tient should be diagnosed with a terminal illness 2. Physician-Assisted Suicide This has been legalized in the US state of Oregon, PAS has been legalized. The patient would perform the active step of ending life and the physician would merely take care the patient.The patient should be diagnosed with a terminal illness (in which death would be certain within 6 months). The patient should be legally competent to make a reasonable decision (Rekel, 2007).ReferencesHoffmann, D. E. (1998). Pain Management and mitigatory Care in the Era of Managed Care Issues for Health Insurers, Journal of Law, medical specialty & Ethics, 26(4), 267-289. http//www. aslme. org/research/mayday/26. 4/26. 4c. php Meisel, A. (2005). Ethics, End-of-Life Care, and the Law Overview, Retrieved on August 16, 2008, from Hospice Foundation Websitehttp//www. hospicefoundation. org/ teleconference/books/lwg2005/meisel_jennings. pdf National Cancer Institute (2002). End-of-Life Care Questions and Answers, Retrieve d on August 16, 2008, from NCI Website http//www. cancer. gov/cancertopics/factsheet/ give/end-of-life-care Rekel, R. (2007). Rakel Textbook of Family Medicine, 7th ed, Philadelphia Saunders Elsevier. Walker, R. M. (1999). Ethical Issues in End-of-Life Care, Cancer Control, 6(2)162-167. http//www. medscape. com/viewarticle/417700_1