Write a case study on one of the following social issues related to death and dying:
? A good death vs. a bad death
? Meeting the cultural and spiritual needs of people who are at their end-stage of life
? The medicalisation approach to death, dying and grief and how it impacts people
? The ethical complexities in patient-centred approaches to death and dying
In your case study, discuss the background to the social issue; explain why this issue is important in multicultural societies such as Australia; discuss the rights of the person who is passing in terms of the policy and legal frameworks involved and the holistic range of skills and knowledge required by professionals to ease the journey of the person and their loved ones.
Drawing on wider international research and practice in this area, make recommendations for how the palliative care journey can be improved for those who are in their end-stage and their loved ones.
This essay needs to include a minimum of 6 references
Good Death vs. Bad Death
End-of-life care concerns the care and support that is given to a patient as they approach death and during the advanced phases of their terminal illness. The purpose of end-of-life care is to manage or minimize the pain and distress of the person who is passing. End-of-life care entails the social, spiritual, emotional, and psychological support given to patients and their families (Jors et al., 2016). Palliative care, which is part of end-of-life care, is a form of care provided to patients living with serious and chronic conditions. One of the main concerns when delivering end-of-life care is ensuring the patient has a comfortable and acceptable death by their own expectations. The paper will discuss what it means to have a good death or a bad death. The paper will also explore the policy and legal frameworks involved as well as the skills and knowledge required for effective end-of-life care.
Comparing a Good and Bad Death
There are varied perceptions about what constitutes a good death or a bad death among different people and in different societies or cultures. The first aspect of a good death is that the patient at the end of life stages is comfortable. The medical care and support provided to the patient is intended to reduce the pain that the patient is going through in their last stages of life. Therefore, a good death is one where the care provided to the patient allows them to have a level of comfort as they approach death. The person who is passing is comfortable if the care enables them to manage their symptoms. Effective end-of-life care allows the patient to live without pain and physical discomfort (Cottrell & Duggleby, 2016). Therefore, the management of the symptoms of the condition as well as the alleviation of pain allows the person to live with minimal distress and anguish in their last stages of life. On the other hand, a bad death is one where the person in the last stages of life experiences pain and suffering during this stage. A bad death means that the care provided to the individual fails to effectively minimize or alleviate the pain. Furthermore, a bad death is characterized by the incapacity to manage or alleviate the physical symptoms of the patient with terminal illness. As such, the person lives with considerable distress during the last stages of life. In this way, the first difference between a good death and a bad one concerns the effectiveness of care professionals to manage and alleviate the suffering of the person who is passing.
The next element that characterizes the type of death is the autonomy of the person in the last stages of life. Every person has a right to make decisions about their care at any stage of their life. Autonomy allows a person to make decisions and to be involved in the decision-making processes involved in their end-of-life and palliative. Therefore, a good death is one where the person who is passing gets to make decisions about their care (Semino et al., 2014). The person has the autonomy to make decisions about the setting in which they will receive care. In a good death, the person who is passing will have the right to choose the kind of setting in which they will receive care (Krikorian et al., 2020). Therefore, a good death allows the person to maintain their autonomy and therefore keep their dignity. On the other hand, a bad death is characterized by a loss of autonomy for the person who is approaching death. In a bad death, the individual is denied the opportunity to make decisions about care, treatment and medical procedures in their last stages of life. Therefore, the lack of autonomy for the person robs them of their dignity at their end of life and also causes them considerable distress. These circumstances create a situation where the individual has a bad death.
The next element of death surrounds the beliefs and traditions of the person who is passing. Each person has unique beliefs and traditions that have a significant influence on how they want to be treated in their end-of-life stage. In a good death, the care professionals who deliver the end-of-life and palliative care make it their responsibility to know and comprehend the cultural or religious traditions, customs and beliefs of the terminally ill patient. The care professionals also take time to ask and understand norms and customs related to the end of life for the particular patient. The understanding allows the care professional to deliver palliative care that is sensitive and respectful of the beliefs and traditions of the patient (Jors et al., 2016). Therefore, a person who is passing will view it as a good death if their beliefs and traditions are honoured by care professionals. Conversely, a bad death is characterized by a disregard of the person’s beliefs and traditions by the people proving care. The care professionals lack an understanding of the person’s beliefs and traditions which means that the care provided will lack any sensitivity to the needs of the person approaching death. Such a situation causes the person distress and sadness at the end of life. Therefore, failure to honour the beliefs and traditions of the person who is passing results in a bad death.
The next aspect that contributes to the perception of whether a death is good or bad is the level of communication and collaboration between all the parties involved. Communication and collaboration between the person who is passing, their family, and the people providing care is a critical component in end-of-life care. As such, a good death can be perceived as one where there is regular and effective communication between the care professionals and the person who is passing and their family (Semino et al., 2014). The care professionals offer information that the patient and their family need to make decisions about their care and medical procedures. Such a situation allows for effective collaboration between all the parties to ensure that the person who is passing can be comfortable during the last stages of their life. Regular communication and collaboration also ease the stress of the person as they approach death. On the other hand, a bad death is noted for a lack of communication and collaboration among the people in the life of the person in their end stages of life. The lack of communication and collaboration has an adverse effect on the quality of palliative care that the patient receives. Such a situation creates considerable discomfort and distress for the person who is passing and ultimately results in a bad death.
Another component surrounding the end of life for most people is their level of preparedness as they approach death. The first aspect concerns the level of acceptance of the approaching death. The person who is passing will have a good death if they know and accept that their death is approaching. Acceptance of the approaching death allows the person to make prudent decisions about their care as well as other aspects of their life. For example, the person who acknowledges and accepts death will put their financial matters in order. Additionally, they will seek to mend broken relations with their loved ones. The acceptance of death allows the person who is passing to make decisions in a way that minimizes the burden on their family (Cottrell & Duggleby, 2016). Care professionals are also involved in preparing the person for their eventual death. The acceptance of death offers closure that allows the person to have a good death. Inversely, a bad death is one where the person who is passing fails to accept their impending death and fails to make adequate preparations for death. The person who is passing will be fearful and worrisome as they approach their death. As such, the person passes on without putting their affairs in order or finding the closure they need. A bad death is also characterized by the failure of the care professionals to prepare the patient for death.
Significance of a Good Death or Bad Death in Multicultural Australian Society
In a multicultural society like Australia, there are varying perceptions about what constitutes a good or bad death among the different people in the country. The differences among the different communities in Australia arise from the varying perceptions about death and the afterlife. There are also notable differences arising from the variety of religious and spiritual beliefs in Australian society. In a multicultural society like Australia, end-of-life care must be culturally sensitive due to the differences in beliefs and traditions among the people. Therefore, people in the country will perceive death to be good if their traditions, customs, and beliefs are respected during the last stages of their life (Kastbom et al, 2017). Cultural differences result in varying views and attitudes towards palliative and end-of-life care. Therefore, a patient-centred approach to care allows the person who is passing to make decisions regarding their care and treatment in the last stage of life. Differences in the perceptions about death within the Australian multicultural society may influence attitudes towards the acceptance of death and the need to find closure. In some cultures, death is accepted as a finality while in other cultures death is a phase between this life and the afterlife. Therefore, the people providing care have to be sensitive towards the views of the patient towards death.
Rights of People who are Passing
In Australia, policy and legal issues surrounding death and dying are governed by state governments. The first such law is the Voluntary Assisted Dying Act 2017. The law was passed by the state of Victoria in November 2017, thereby making it the first Australian state to have a law allowing physician-assisted suicide (Vic.gov, 2021). Under the Voluntary Assisted Dying Act, a person living with a terminal illness is granted the right to seek physician-assisted suicide if a medical determination shows that they have less than six months to live. The law requires the person who chooses physician-assisted suicide to have lived in Victoria for at least 12 months and that they make an informed decision to undergo the procedure. The law also requires an increase in funding for palliative care. The next state to pass a law around the rights of people who are passing is Western Australia. In 2019, the state passed the Voluntary Assisted Dying Act.
Currently, the states of Victoria, Western Australia, Queensland, South Australia, and Tasmania have laws providing for physician-assisted suicide and euthanasia. The only states that are yet to pass laws allowing for either physician-assisted suicide or euthanasia are New South Wales and the Northern Territory (AP, 2021). As such there are varying policy and legal frameworks across Australia in terms of whether people who are passing can access the services and procedures they require to make their death good or bad. For instance, people who live in states that have laws allowing for physician-assisted suicide can access the procedure and therefore have a good death. In states without such a provision, the person who is passing will be unable to have a physician-assisted suicide if they choose so. Such a person would consider their death to be bad since they have been denied a death of their choice. Therefore, the differences in the policy and legal framework across Australia influences perceptions about a good or bad death.
End-of-Life Care: Skills and Knowledge Required of Professionals
Firstly, professionals involved in delivering end-of-life care and support need the requisite knowledge about the management of the symptoms of the patient. The care professional needs knowledge on the various care procedures that will alleviate the patient’s patient and relieve their suffering (Reincke et al. 2010). As such, there is a need for care professionals to acquire knowledge on the effective management of various serious and chronic conditions. Secondly, professionals who provide end-of-life care and support have to possess knowledge about the patient-centred approach. The professional needs to know how to deliver end-of-life care focused on the unique wishes and needs of the patient. The professional needs to be accepting of the choices of the patient regarding the care they desire as they approach death.
The most critical skill for professionals who provide end-of-life care is effective communication. Professionals need to be exceptional communicators because one of their primary roles is providing information to the patient. As such, the professional needs communication skills to allow them to effectively convey information to the patient as well as the patient’s family about the condition of the patient, their progress, and other sensitive matters related to the end of life (Swami, 2018). The second skill required of professionals involved in end-of-life care is empathy. Care professionals should be empathetic towards the condition patient and take steps to alleviate the patient’s pain. The professional should also have the skills to offer emotional and psychological support to the patient and their families during the last stage of life.
Care professionals should take steps to manage the symptoms of the patient to minimize suffering and pain during the palliative care journey. The palliative care provided should be grounded in patient-centred care. In this way, palliative care should focus on the unique preferences, needs, and wishes of the patient. Care professionals can improve the palliative care journey for the patient and their loved ones through regular communication. Regular correspondence ensures that everyone involved in the journey is equipped with the necessary information to make decisions about the care of the patient. Any information about the prognosis of the patient should be delivered with empathy and compassion to ease the psychological torment of the patient and their loved ones (Swami, 2018). Moreover care professionals should respect and show sensitivity towards the beliefs and customs of the patient.
Cottrell, L., & Duggleby, W. (2016). The “good death”: an integrative literature review. Palliative & supportive care, 14(6), 686-712.
Jors, K., Seibel, K., Bardenheuer, H., Buchheidt, D., Mayer-Steinacker, R., Viehrig, M., … & Becker, G. (2016). Education in end-of-life care: what do experienced professionals find important? Journal of Cancer Education, 31(2), 272-278.
Kastbom, L., Milberg, A., & Karlsson, M. (2017). A good death from the perspective of palliative cancer patients. Supportive care in cancer, 25(3), 933-939.
Krikorian, A., Maldonado, C., & Pastrana, T. (2020). Patient’s perspectives on the notion of a good death: a systematic review of the literature. Journal of Pain and Symptom Management, 59(1), 152-164.
Reinke, L. F., Shannon, S. E., Engelberg, R., Dotolo, D., Silvestri, G. A., & Curtis, J. R. (2010). Nurses’ identification of important yet under-utilized end-of-life care skills for patients with life-limiting or terminal illnesses. Journal of Palliative Medicine, 13(6), 753-759.
Semino, E., Demjén, Z., & Koller, V. (2014). ‘Good’and ‘bad’ deaths: Narratives and professional identities in interviews with hospice managers. Discourse Studies, 16(5), 667-685.
Swami, M. (2018). Effective Palliative Care: What Is Involved? Cancer Network. https://www.cancernetwork.com/view/effective-palliative-care-what-involved
Vic.gov (2021). Voluntary assisted dying. Department of Health – Victorian Government. https://www.health.vic.gov.au/patient-care/voluntary-assisted-dying
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