Safety, Quality, and Informatics

RUNNING HEAD: END-OF-LIFE DECISIONS 1

END-OF-LIFE DECISIONS 2

End-of-Life Decisions

Samantha M. Tallarine

Capella University

Policy, Law, Ethics, and Regulations

May, 2019

Role of the Nurse in End-of-Life Decision-Making

“End-of-life nursing encompasses many aspects of care: pain and symptom management, culturally sensitive practices, assisting patients and their families through the death and dying process, and ethical decision-making” (Hebert, Moore & Rooney, 2011). Nurses are playing crucial roles in the in end-of-life decision making regarding the patients and other members of family. Clarification of the family roles is the first role that is played by nurses. The families of the patients sometimes also develop some roles which are majorly informal. For instance, there are roles that are dedicated to the members of family regarding provision of primary care. Suppose a person becomes seriously ill, before their stay in the Intensive Care Unit, there is always a member of the family who is supposed to act as the primary caregiver. However, the individual acting as the primary caregiver may serve as the primary decision maker or not. Moreover, nurses play another part in the process of deciding end-of-life by advocating for their patients, and communicating with the patients and their family members.

It is extremely important that patients facing the end of their life remains comfortable, and if possible “have some pleasure in daily life” (Nakano, Sato, Katayama & Miyashita, 2013). In helping the patients and administering palliative care, or assisting them in making their plans, nurses help the patient to remain autonomous. Nurses spend the most time with the patients, so it works best to have them help patients and their family members in this time of need to understand all their options. That is one of the biggest roles that the nurse can play when it comes to patient’s making decisions about their end-of-life care.

Legislation that generated end-of-life health care policies

Patient Self Determination Act (PSDA) is the legislation that led to the generation of the end-of-life healthcare policies; Congress enacted it in the year 1991. The act mandates that the facilities of healthcare that were receiving Medicare funding or aid were required to provide the patients with written information indicating the rights of the patients to get involved in the medical decision making alongside writing advanced directives. The legislation was as a result of concern from various persons who were having significant concerns with the policies of health care and not for a medical case that was specified. The people who were concerned in the healthcare policies had interests in ensuring that patients are allowed to take part in the process of making decisions. The healthcare, proxies, and living wills alongside all other advanced directives are enabling the patients to decide on the kind of measures they do or do not want to be used if they become debilitated.

Primary policies regarding current health care practices

Oregon’s Death with Dignity Law is one of the policies that was put in place in 1997 to allow adult Oregonians who were terminally-ill to utilize self-administration of doses of medications which are lethal. Secondly, there is a policy of death with dignity act that Oregon passed about healthcare decision-making. The law was enacted to allow patients who were dying with choices of ending their lives and ensuring that the patient remains autonomous throughout the rest of their life. This can help those with agonizing terminal illnesses escape some of their inevitable suffering.

Ethical Considerations that have influenced policy decisions

Autonomous Decision Making is one of these ethical considerations. Making this decision is one of the processes of thoughts that are complex and is setting up various challenges for both the patients and their members of families towards coming up with healthcare decision regarding the end of life. People have the chance to make decisions regarding there end of life treatment preferences. Additionally, there is ethical consideration that is influencing decision policy with reference to the end-of-life healthcare decisions in directives that are advanced are usually allowing persons who are competent to prototype as well as engage in the documentation of the decision plan with regard to healthcare in advance directives suppose they become incapacitated in the future Healthwise  (Leach, 2016, p. 39).

Resources

Hebert, K., Moore, H., & Rooney, J. (2011). The Nurse Advocate in End-of-Life Care. The Ochsner journal, 11(4), 325–329.

Leach, D. R., (2016). Ethics and end of life issues. Oxford Medicine Online.

Meyers, D. E., & Goodlin, S. J., (2016). End-of-Life Decisions and Palliative Care in Advanced Heart Failure. Canadian Journal of Cardiology, 32(9), 1148-1156.

Nakano, K., Sato, K., Katayama, H., & Miyashita, M. (2013). Living with pleasure in daily life at the end of life: Recommended care strategy for cancer patients from the perspective of physicians and nurses. Palliative & Supportive Care, 11(5), 405-13. doi:http://dx.doi.org.library.capella.edu/10.1017/S1478951512000442

Norlander, L. (2014). To comfort always a nurse's guide to end-of-life care. Retrieved from https://ebookcentral-proquest-com.library.capella.edu

Zaal-Schuller, I., Willems, D., Ewals, F., Van Goudoever, J., & De Vos, M. (2016). How parents and physicians experience end-of-life decision-making for children with profound intellectual and multiple disabilities. Research in Developmental Disabilities, 59, 283-293.