End of Life Care Discussion Paper

End of Life Care Discussion Paper

End of Life Care Discussion Paper

End-of-life care presents complex medical problems and ethical dilemmas, especially between healthcare teams and the patient’s family. The issues usually surround conflicting treatment intervention choices. Healthcare providers especially nurses, are tasked with ensuring that the quality of life, dignity, and comfort of incapacitated patients are maintained. Nurses have the role of commencing discussions about end-of-life care with the patients and their families, facilitating the expression of advance directives and living wills, and ensuring implementation of these directives in patient care (Dowling et al., 2020). Nurses are ethically and legally mandated to ensure that patient autonomy is maintained by implementing patient care according to the advanced directives.

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Advanced directives and living wills are essential in guiding patient-centered end-of-life care per the patient’s wishes. Advanced directives are legal documents that are finalized before medical decisions and direct preferred patient healthcare interventions and designated healthcare proxies if the patient may not have the capacity to make the decisions (House et al., 2022). Living wills, a type of advanced directive, make provisions on the patient’s preferred treatment options concerning end-of-life interventions such as life-sustaining care, cardiopulmonary resuscitation, mechanical ventilation, and defibrillation among others (Baker et al., 2020). Availability of these documents should be confirmed before initiating care and any updates made before illness during patient contact.

Challenges of advanced directives use exist. These include confusion regarding these documents, availability, and accuracy of the directives, and patient and family bedside wish that differ from documented directives (Baker et al., 2020). This will require collaboration between the stakeholders to arrive at satisfactory decisions while respecting the patient’s preferences. There was a clinical situation involving a patient in a coma secondary to severe brain injury hence could not give consent. Treatment decisions of patients with disorders of consciousness are dependent on the advanced directives of the patient together with surrogate judgment from health proxies (Graham, 220). Based on this knowledge, despite conflicting preferences among the patient’s family members on whether to continue life-sustaining interventions, the patient’s autonomy was maintained by keeping him on life support based on his choice in the advanced directive.

References

Baker, E., & Marco, C. (2020). Advance directives in the emergency department. Journal Of The American College Of Emergency Physicians Open, 1(3), 270-275. https://doi.org/10.1002/emp2.12021

Dowling, T., Kennedy, S., & Foran, S. (2020). Implementing advance directives-An international literature review of important considerations for nurses. Journal of Nursing Management, 28(6), 1177–1190. https://doi.org/10.1111/jonm.13097

GRAHAM, M. (2020). Precedent Autonomy and Surrogate Decisionmaking After Severe Brain Injury. Cambridge Quarterly Of Healthcare Ethics, 29(4), 511-526. https://doi.org/10.1017/s0963180120000286

House, S. A., Schoo, C., & Ogilvie, W. A. (2022). Advance Directives. In StatPearls. StatPearls Publishing.

 

Discuss both the role and legal obligations of the AGACNP in facilitating end-of-life care, including advanced directives and living wills. Differentiate between advanced directives and living wills.
Incorporate a terminal disease state explaining the treatment options as it relates to advance directives and living wills.
Discuss a time when family members may have disagreed with the patient’s requests. How did you handle the situation?