Introduction
End-of-life issues are multiple and often painful for patients and their families. People who are faced with the impossibility of overcoming the disease may experience emotional pain, despair, or frustration, and without support and social interaction, their suffering may worsen. The ability to decide for yourself when the last minute of life will come can ease the moral and emotional state of a dying person (Andriessen et al., 2019). This paper argues that a PAS decision should not be seen as a solution to the patient’s problems as it is the central element of self-management for patients with chronic disease.
Before Watching the Video “A Death of One’s Own”
Personal opinion on end-of-life issues
I am convinced that people should have the right to choose to die, but this right should not be used to solve psychological and emotional problems. The results of a recent study showed that people who were choosing PAS or euthanasia “generally had similar or lower scores on measures of disordered grief, mental health, and posttraumatic stress compared with those who died naturally” (Andriessen et al., 2019, p. 2151). Doctors and nurses must help patients overcome sadness because the last months of life can be very important for a person and his loved ones.
Many people rethink their lives during this time, overcome long-standing emotional conflicts, and realize death is an integral part of life. However, peaceful dying is impossible when a person is in social isolation when they do not receive enough attention, love, and support. Scientists emphasize that “lack of social support and secrecy may compound grief” (Andriessen et al., 2019, p. 2151). Andriessen et al. (2019) also note that involving the patient in the decision-making process and honoring the patient may facilitate grief. A misunderstanding of the goals of PAS can lead to confusion when patients see it as a way to get rid of emotional pain.
After Watching the Video “A Death of One’s Own”
Cost of having a chronic disease
In many cases, healthcare-related expenses are covered by medical insurance. However, compared to the years 1996-1999, which are depicted in the documentary, today there are growing numbers of patients who are uninsured and become helpless when diagnosed with chronic illness. Recently, telemedicine has become increasingly popular, due to its potential to save money spent on treatment (Nouri et al., 2020). The emotional cost is also important, and the extent of it was demonstrated in the episodes about Jim (“A Death of One’s Own”). Jim, his wife, and his family were facing contradictory feelings that were hard to embrace. Jim was embarrassed with shame, fear, and sadness, while his wife experienced compassion, love, shame, and confusion. For Jim’s children, the visits were also not so smooth, as his daughter admitted she couldn’t accept the fact that her father was dying.
Issues caretakers of terminally ill patients face
Having a chronic disease can be overwhelming in many aspects. However, as it was shown in the documentary, in most cases the loving family provides adequate care and support for their dear family members who have chronic illnesses. Jim’s case is the most illustrative in this regard, as his illness involves a slow and gradual loss of body mobility (“A Death of One’s Own”). Jim’s wife faced such issues as fatigue from providing care, feelings of shame, and contradictory feelings of compassion, sorrow, grief, love, and willingness to go on with living a full life while providing care.
The patients and their caretakers usually go through the treatment guided by some nursing self-management theory. The self-regulation theory implies that “a person is motivated to self-regulate by the desired goal or behavioral endpoint,” while “the power of the goal is associated with a value that the goal represents for the individual” (Allegrante et al., 2019, p. 127). In the social-cognitive theory, the self-efficacy beliefs operate together with treatment goals, as self-efficacy is seen as “one’s confidence or personal agency to exercise control,” which is “a common pathway through which psychosocial factors influence health functioning” (Allegrante et al., 2019, p. 127). These theories illustrate the psychological processes underlying patients’ daily lives, as self-care or assisted care becomes a new routine that intertwines with ordinary lives.
Change of personal opinion on end-of-life issues
Before watching the documentary, I had only general ideas about end-of-life issues, which could not serve as a basis for forming a clear opinion. After watching the documentary and studying the issue, I better realized how the fear of death and the preparation for dying and making the corresponding decisions are among the most sensitive aspects people face when being chronically ill. When physicians are working with terminally ill patients, they should understand that their psychology was to some extent adjusted to the treatment process they are going through every day.
I also found out that doctors fully understand the responsibility of supporting patients in their decision to end their lives. This decision applies only to patients who have a diagnosis of incurability (“Physician-assisted suicide”). Doctors do not leave patients after diagnosis but accompany them and provide treatment until their last breath. Equally important, doctors express respect for patients, and responsibility for the decision or initiative regarding PAS always comes from the patient.
Conclusion
Thus, it was argued that the decision regarding PAS is an important element of self-management for chronically ill patients and it should not be seen as a solution to the patient’s problems. On the contrary, doctors must continue to treat and support the patient, and respect him and his family. Financial and emotional costs can be overwhelming, and the PAS decision is a central issue for the patient and their family. Hence, medical practitioners pay utmost attention to discussing this issue and, while providing the patient with the information about the option, should take any other possible steps to assist the patient with peaceful dying, whether with or without special pills.
References
A Death of One’s Own (2000) [Video file]. Web.
Andriessen, K., Krysinska, K., Dransart, D. A. C., Dargis, L., & Mishara, B. L. (2019). Grief after euthanasia and physician-assisted suicide. Crisis, 41(4), 2151-2369.
Allegrante, J. P., Wells, M. T., & Peterson, J. C. (2019). Interventions to support behavioral self-management of chronic diseases. Annual Review of Public Health, 40, 127-146.
Nouri, S., Khoong, E. C., Lyles, C. R., & Karliner, L. (2020). Addressing equity in telemedicine for chronic disease management during the Covid-19 pandemic. NEJM Catalyst Innovations in Care Delivery, 1(3).
Physician-assisted suicide (n.d.). AMA. Web.