The guardian's decision to withdraw or withhold life-sustaining treatment must be filed with 2 witnesses, one of whom is the attending physician. The guardian may be a parent, adult sibling, healthcare provider, the CEO of the health facility or the commissioner of an agency in charge of mentally retarded who are terminally ill. Healthcare practitioners need to understand the state and local laws governing the delivery system. They should also reach out to the guardian who may be unaware of these laws. If refusing medical care is not allowed by these laws, guardians should resort to active lobbying (King).
Nurses' Values and Managing Pain and Ethics
Unprecedented medical advances view death as a disease that must be treated rather than as a natural event in life (Zomorodo and Lynn 2010). Sophisticated technological interventions enable Americans to live through chronic conditions for an average of 17 years. In the critical care unit especially, this view of death has separated the patient and family from the natural dying experience. As a result, they are rendered unaware of approaching death and unable to prepare for it. Death has come to be viewed as a medical failure. Healthcare professionals see the patient as a disease or condition instead of an individual with personal values and desires. He and his family are deprived of the patient-centered care they need precisely at the moment. Nurses, therefore, must include them in the decision-making process and help them through the technology used. Nurses need to provide that patient-centered care in order to improve the patient's quality of dying and raise the level of satisfaction on all sides (Zomorodo & Lynn). (Kirk 2007)
Home hospice nurses are not always able to fully meet their ethical obligations to patients (Kirk 2007). Often, the most these nurses can accomplish is incorporate the select family members into delivering the best palliative care possible. The use of evidence-based strategies does not guarantee that ensuing death will be free of symptoms and family members' full participation in the care. This is particularly the case when family members do not adequately palliate the patient and otherwise-treatable symptoms produce distress during the dying process. These failures often produce moral distress and a sense of failure in nurses (Kirk).
Point-of-View
BIBLIOGRAPHY
Bimbacher, D. (2007). Terminal sedation, euthanasia and causal roles. Medscape General Medicine: Medscape. Retrieved on August 8, 2010 from http://www.medscape.com/viewarticle/556486
Cardoso, T et al. (2003). Life-sustaiing treatment decisions in Portuguese intensive care units: a national survey of intensive care physicians. Critical Care: Biomed Central
Ltd. Retrieved on August 8, 2010 from http://www.medscape.com/viewarticle/464501
King, E.L. (2007). Refusing medical care in New York state: politics and implementation of policy. 7 (3) Current Opinion in Gastroenterology: Medscape.
Retrieved on August 8, 2010 from http://www.medscape.com/viewarticle/563675
Kirk, T.W. (2007). Managing pain, managing ethics. 8 (1) Pain Management Nursing:
Elsevier Science, Inc. Retrieved on August 8, 2010 from http://www.medscape.com/viewarticle/557072
Meissner, A. et al. (2010). Epidemiology of, and factors associated with, end-of-life decisions in a surgical intensive care unit. 38 (4) Critical Care Medicine: Lippincott
Williams & Wilkins. Retrieved on August 8, 2010 from http://www.medscape.com/viewarticle/719638
Schwartz, J.K. (2004). The rule of double effect and its role in facilitatig food end-of-life palliative care. 8 (2) Journal of Hospice and Palliative Nursing: Lippincott Williams & Wilkins. Retrieved on August 8, 2010 from http://www.medscape.com/viewarticle/474834
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