Facing death is regarded to be a serious challenge for people, resulting in a natural wish to control their last days. Still, sometimes patients might become unconscious or incompetent to make decisions at their last life stage. Therefore, health care institutions are working towards improving care for patients at the end of life suggesting them advance care planning that includes a living will, as well as do-not-resuscitate (DNR) and do-not-hospitalize (DNH) options. The main purpose of these documents is to respect the patients’ autonomy by taking into account their preferences and wishes to ease the process of dying and avoid unwanted interventions that might cause further suffering and pain.
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It is believed that the decision-making process related to end-of-life medical activities might be rather painful for patients and their relatives. Nursing staff plays a significant role in this process as nurses are traditionally establishing a positive relationship with the patients who might prefer to talk to them about their wishes. Nursing professionals are also capable of providing competent information about possible options in advance care planning and explain possible positive and negative outcomes.
It is stated that “in nursing homes, DNH orders may often be the result of a more extensive process of discussing and planning future care” (Brinkman-Stoppelenburg, Rietjens, & Van der Heide, 2014, p. 1020). Thus, many patients prefer avoiding hospitalization and extensive interventions at the last stage of life as they are causing additional suffering.
Legislation that Regulates End-Of-Life Decisions
The main legislation that regulates end-of-life care policies is a written advance directive. In this document, an individual can select and appoint a surrogate to make health decisions in case one is unable to do it oneself, as well as describe certain wishes towards end-of-life care including preferable methods of treatment. This legislation is a result of the study of clinical realities related to end-of-life care and is oriented towards improving its quality while respecting the autonomy of patients.
For instance, many patients who suffer from chronic diseases such as cancer or heart disorders might select DNR and DNH options as a part of their end-of-life decisions. It is stated that experienced health care professionals in many hospitals are usually acting in the interests of the patients and are not making recommendations against suggesting resuscitation when it is clinically appropriate (Dzeng et al., 2015). Still, in some cases, artificial sustaining of life might cause negative effects and prolong suffering, especially in patients with chronic diseases.
Primary Policies Regarding Current Health Care Practices
The primary policies regarding current health care practices are completely patient-oriented. That is why completing an advance directive is highly recommended for competent adults to ensure appropriate treatment according to individual preferences and beliefs. It is stated that “the aging of the baby boomers will mean a sharp increase in the number of U.S. patients with Alzheimer’s disease, which will place new pressures on families and care systems” (Wolf, Berlinger, & Jennings, 2015, p. 680). Therefore, advance care planning might help to avoid unwanted outcomes and improve the quality of end-of-life care.
End-Of-Life Regulations and Choices
End-of-life regulations give people an opportunity to take part in the shared decision-making towards the medical intrusions and activities that physicians might offer to sustain one’s life. It has a positive effect on the relationship of patients with nursing staff as they help in the decision-making process. Some researchers state that “ethics and communications at the end of life are generally present in the medical school and residency didactic curricula, but lack of time and space on the wards for reflection might promote an excessive, unreflexive deference to patient autonomy” (Dzeng et al., 2015, p. 817). Still, ethical considerations such as the right of the patient to autonomy in the selection of treatment and end-of-life care options greatly influence policy decisions in advance care planning to provide comfort and pain-free death at the end of life.
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Controversial cases of death are inevitable in health care practice. The practice is significantly different from the theory when it comes to end-of-life care. Thus, advance care planning might assure that patients’ wishes towards medical interventions at the last stage of life will be heard and respected.
Brinkman-Stoppelenburg, A., Rietjens, J. A., & Van der Heide, A. (2014). The effects of advance care planning on end-of-life care: A systematic review. Palliative Medicine, 28(8), 1000-1025.
Dzeng, E., Colaianni, A., Roland, M., Chander, G., Smith, T. J., Kelly, M. P.,… Levine, D. (2015). Influence of institutional culture and policies on do-not-resuscitate decision making at the end of life. Journal of American Medical Association Internal Medicine, 175(5), 812-819.
Wolf, S. M., Berlinger, N., & Jennings, B. (2015). Forty years of work on end-of-life care — from patients’ rights to systemic reform. The New England Journal of Medicine, 372(1), 678-682.