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Ethical Decision Making On End of Life Issues

June 10, 2011 Leave a comment

Different Strokes, child actor, Gary Coleman passed away in May 2010 after suffering a fall in his home that resulted in brain hemorrhaging, the next day, coma and his being put onto a life support system. According to multiple sources, Coleman’s Will stated his wish to not have his life prolonged if two doctors agreed that his condition was terminal. However, in the same document he also added the stipulation that if he was in a comatose state for 15 days, he wished to have life support removed at that point. As reported in articles on his passing, life-support systems were removed after only one day at the request of his ex-wife and partner.

End-of life decisions similar to this are made every day in Intensive Care Units in hospitals across the country, involve decisions that are complicated, emotionally charged, and usually involve the patients’ wishes, family, and the healthcare providers. Many times the end-of-life decision making process begins when the near death state of a patient suffering from disease, complications from stroke, heart attack, Alzheimer’s and other conditions involves the fact that life could not be sustained without life support; has been deemed terminal; and there is an absence of any prognoses for recovery. Advances in medical technology increases the ability to prolonglife and ironically, sometimes cause roadblocks in this difficult end-of-life decision-making process. New drugs, devices, and procedures become available every day for usein hospitals that increase the ability to counteract or modify theeffects of diseases or injuries caused by accidents that, in the past, were fatal.

Slowly Dying by *photonig on deviantART

With all of the enthusiasm surrounding technology and cure and often times, the need for imminent action, sometimes patients’wishes, quality of life, and consideration of the burden oftreatment to the patient compared with the benefit are overlooked.
Communication between healthcare providers and family members and consideration of the patients’ previously documented or expressed wishes are critical in making an ethical end-of-life decision. The request for a meeting of a multidisciplinary ethics committee that includes physicians, nurses, a social worker, a chaplain and the family members is sometimes used to inform and “sort out” the many factors involved in making a final decision that allows for the patients’ peaceful passing.

800Seniors.com is a leading referral system in the Elderly Healthcare industry. We are located on 5400 Atlantis Court, Moorpark, California 93021. 800Seniors.com provides the perfect match between seniors searching for health care provisions such as Home Care Chicago, Home Health, Skilled Nursing, Hospice Care, Medical Supplies, as well as a variety of Assisted Living Facilities and Care Homes nationwide. Take the confusion and hassle out of the search. For more information call 1-800-768-8221, visit http://800seniors.com or fax us your details at (805)517-1623.

About The Author: Gloria Ha’o Schneider is an expert in senior citizen and baby boomer issues. Her topics revolve around Senior Living and Healthcare to provide the latest information to this demographic as well as their families and loved ones.

End-of-Life Decisions: Should The Government Be Involved?

June 10, 2011 Leave a comment

Five years after Terri Schiavo died after having a Court ordered removal of her feeding tube, experts on End-of-Life issues say not much has changed. It’s estimated that only 20%-30% of Americans have advance care directives, about the same number as in 2005. The Schiavo case turned into a 7-year legal battle between Terri’s husband and her parents after she suffered a cardiac arrest on February 25, 1990. She suffered massive brain damage due to lack of oxygen and, after two and a half months in a coma, her diagnosis was elevated to vegetative state. For the next few years, doctors attempted physical therapy and other experimental therapy, hoping to return Terri to a state of awareness, but the legal battles ensued. At issue was whether the equipment that was being used to sustain her life since 1990 – specifically a feeding tube– should have been disconnected, thereby allowing her to die.

Also at issue was the absence of a living will or any end-of-life directive. A trial was held during the week of January 24, 2000, to determine what Terri’s wishes would have been regarding life-prolonging procedures. Testimony from eighteen witnesses regarding her medical condition and her end-of-life wishes was heard. Her husband, Michael Schiavo claimed that Terri would not want to be kept on a machine when her chance for recovery was minuscule. According to Abstract Appeal Trial Order, her parents “claimed that Terri was a devout Roman Catholic who would not wish to violate the Church’s teachings on euthanasia by refusing nutrition and hydration.” Judge George Greer issued his order granting Michael’s petition for authorization to discontinue artificial life support for his wife in February 2000. In this decision, the Court found that Terri was in a persistent vegetative state and that she had made reliable oral declarations that she would have wanted the feeding tube removed.

life line? by *forcedtobeanartist on deviantART

Without passing judgment on whether this one issue of not having an end-of-life directive would have prevented the public, personal and political catastrophe that ensued, experts stress the importance of such a document for avoiding uncertainties in such a difficult personal and moral decision. The rehabilitation efforts for Terri Schiavo lasted three years. The legal cases surrounding this end-of-life issue lasted seven years from 1998-2005 and included the following Court proceedings:

·Petition to remove feeding tube ·Schiavo I: end-of-life wishes ·Oral feeding and the Second Guardianship Challenge ·Schiavo II- In April 2001, Terri’s parents filed a motion for relief from judgment citing new evidence of Terri’s wishes but the Court denied it. ·Schiavo Second feeding tube removal and state involvement: Terri’s Law ·Sciavo III & IV: PVS diagnosis challenge ·Final feeding tube removal and federal involvement.

800Seniors.com is a leading referral system in the Elderly Healthcare industry. We are located on 5400 Atlantis Court, Moorpark, California 93021. 800Seniors.com provides the perfect match between seniors searching for health care provisions such as Home Care Houston, Home Health, Skilled Nursing, Hospice Care, Medical Supplies, as well as a variety of Assisted Living Facilities and Care Homes nationwide. Take the confusion and hassle out of the search. For more information call 1-800-768-8221, visit http://800seniors.com or fax us your details at (805)517-1623.

About The Author: Gloria Ha’o Schneider is an expert in senior citizen and baby boomer issues. Her topics revolve around Senior Living and Healthcare to provide the latest information to this demographic as well as their families and loved ones.

End Of Life In A Skilled Nursing Facility

May 13, 2011 Leave a comment

Although most people say they would prefer to die at home, approximately 56 percent die in a hospital and roughly, 22 percent of all U.S. deaths occur in skilled nursing facilities. According to a study conducted by Brown Medical School researchers and published by AARP, the 1 in 4 adult Americans who die in a skilled nursing facility are not always receiving the appropriate care such as pain medication, emotional support and hospice care. In the report, experts offered several recommendations to improve end of life care in skilled nursing facilities. One of the most critical: Improve government reimbursement rates.

“Listening to families’ compelling stories of end of life care, it is clear that nursing homes need more staff and better training for that staff,” said Terrie Wetle, Associate Dean of medicine for public health and public policy and professor of community health at Brown Medical School. “Workers also need to be better paid,” Wetle said. “Even at the best facilities, aides are frequently offered wages that are about what they’d make working at McDonald’s.” But many homes simply don’t have the funds. Another fundamental finding: Appropriate care often isn’t provided because staffers simply don’t recognize that a patient is dying.

Researchers noted that symptoms of terminal illness are often difficult to identify and illness trajectories hard to predict, resulting in additional caregiver burdens, late decisions about hospice care and unnecessary transfers to other skilled nursing facilities. The team also found that dying residents were subjected to unneeded tests or treatments – for example, a comatose resident was restrained in a wheelchair and put in whirlpool bath. The team heard other consistent themes: Doctors that were “missing in action”; aides were overworked and under trained; care was task focused rather than person centered; hospice referrals were made too late or not at all; and, due to a lack of trust, family members found it necessary to become vigilant advocates for their spouses, parents or grandparents.

My daddy by *nicolehinrichs on deviantART

In the 1900’s people often died at home surrounded by family. Physicians routinely comforted the dying and their families. In the past century, medical and public health advances have almost doubled the average life expectancy, from less than 50 years to nearly 80. People who die in old age tend to experience a long period of functional decline before death, and thus require intensive caregiving and well coordinated skilled nursing care. As medical advances have allowed us to delay death, our society has moved death out of the home and into institutions. The United States has become so caught up in the ability to cure disease that our healthcare system forgets that death is inevitable. In an attempt to remember death and reduce costly inpatient hospital stays at the end of life, Medicare established a hospice benefit in 1983.

Hospice was seen as an alternative for use when life prolonging options had been exhausted. The Medicare hospice benefit is available only to patients whose doctors are willing to certify they have a life expectancy of 6 months or less, who agree to receive only palliative care and who have a full time primary caregiver or reside in any type of assisted living facility. Unfortunately, too few patients receive adequate end of life palliative care. The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments documented the type of care dying patients in teaching hospitals preferred, and how closely their wishes were followed. The investigators found that patients’ wishes were frequently not followed, and that pain was common. Half the patients able to communicate in the last 3 days of life said they were in severe pain. These findings demonstrate the need for the health system to pursue a higher standard for end of life care in any setting.

800Seniors.com is a leading referral system in the Elderly Healthcare industry. We are located on 5400 Atlantis Court, Moorpark, California 93021. 800Seniors.com provides the perfect match between seniors searching for health care provisions such as Home Care, Home Health, Skilled Nursing Los Angeles, Hospice Care, Medical Supplies, as well as a variety of Assisted Living and Care Homes nationwide. Take the confusion and hassle out of the search. For more information call 1-800-768-8221, visit http://800seniors.com or fax us your details at (805)517-1623.

About The Author: Gloria Ha’o Schneider is an expert in senior citizen and baby boomer issues. Her topics revolve around Senior Living and Healthcare to provide the latest information to this demographic as well as their families and loved ones.

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