End-of-life decision making is often a daunting task for many clinicians and health workers. It often involves a situation where critical decisions such as whether to turn off a life support machine should be done or not. Another critical resolution involves initiation of a cardiopulmonary resuscitation when a patient experiences a cardiac arrest. Owing to the critical condition of the patient, they lack the ability to make a decision on ending their life and hence the decision lies solely in the hands of the family. In most scenarios, the patient is sent home as they await their final moments, and a nurse administered to offer the needed care to the patient. In the course of this analysis some factors that will be established involve: The role of the nurse in this process, the primary policies which define current health care practices, the effect of end-of-life regulations, legislation surrounding the matter and also the ethical considerations which influence policy decisions.
Role of the Nurse
There are a number of things that ought to be considered when a nurse is taking up the role of looking after a patient in the end-of-life decision making. First of all, such a nurse ought to be qualified ( Norlander, 2014 ). This involves having the relevant resource knowledge regarding the illness and how to administer care. The nurse also has to be an advocate at a medical facility who is in contact with physicians in the event that the patient`s conditions becomes critical( Lewis, 2013 ). The significant role of this nurse is to carefully guide the patient through the last moments of their life and hence they should be well skilled in doing so.
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One of the effective strategies pertaining to the process is communication. This involves, clarity, specificity regarding expectations, assisting patients and patients to cope with the situation, and also avoidance of euphemism ( Norlander, 2014 ). Assessment also has to be thoroughly undertaken by identification of detrimental conditions and other health associated risks. Constant talk pertaining to death should happen once in a while in order for the patient to be adequately prepared.
Primary Policies
Various policies in the medical field have been established in a bid to offer clarity based upon end-of-life decisions. For instance, there has to be sufficient evidence to show that the patient`s chances of recovery are minimal. Initially, end-of-life was not been offered by hospitals owing to the criminal nature of the act, or rather, because the hospitals feared to be victimized in such a case ( Lewis, 2013 ). Over time, however, various legal injunctions have been made on the matter and currently, patients along with their close confidants are at liberty to sanction such procedures to be initiated. The health care professionals have now come to a point whereby they offer medical advice to the patient based upon their condition( Lewis, 2013 ). They also constantly prepare the patient and their family in the event of such an undertaking. In addition to this, they are under the obligation of recording the entire procedure leading to the end-of-life of a particular patient.
Effect of end-of-life
Regulations pertaining to end-of-life have worked effectively in controlling outcomes of various patients suffering from terminal illnesses. For instance, without regulations, life can be wrongfully terminated in the event that one does not require providing substantial evidence. The laws pertaining to end-of-life also help in regulating the behavior of various medical practitioners such as nurses while tending to critically ill individuals, and also to know the process involved in making such termination ( Norlander, 2014 ). Such laws also ensure that Advanced Care Plans on such patients are considered in light of the matter. This involves undertaking negotiations with close family members in case the patient is not in a position to make a decision based on their condition ( Lewis, 2013 ). Alternatively, only a health care professional is in a position to make a sound decision based on end-of-life of a particular patient. In essence two medical practitioners in a health facility first assess the patient`s condition upon his physician`s claim that the family wishes to put the patient off life support. A unanimous decision to terminate life is then arrived at once it has been considered that there is no chance for the patient to recover.
Legislation
Following the establishment of death with dignity law in Oregon, other communities across the world have come up with similar laws pertaining to terminal ailments. Physicians are, however, only allowed to prescribe such medication and not administer it. Since the initiation of such laws, many patients have opted to end their lives, with the greater majority citing loss of autonomy, followed closely by inability to perform duties that bring about happiness in life and also loss of their dignity ( Hebert, Moore & Rooney, 2011 ). Nurses who are opposed to the idea are not under any obligation to perform the procedure. They can instead delegate care for such a patient to another ethically qualified person. On the other hand, they can continually offer care up until the moment that the patients decides to end their life.
The law requires that in the event that the patient is a vegetative state that shows no hope of recovery then they can wiling fully be allowed to withdraw life support. In the event that the patient is incapacitated in any way and hence not in a position to make a decision, immediate family members are allowed to make the end-of-life decision on the patient ( Norlander, 2014 ). Some laws, however, require that the decision maker to offer convincing evidence showing that the patient would have wanted the withdrawal of life support. Laws pertaining to end of life were passed after it emerged after many patients expressed their wish to have their lives ended. Alternatively, in most cases, majority of families were constantly accumulating huge medical bills by placing this patients under life support yet chances for recovery were very minimal.
Ethical Considerations
There are various ethical considerations which have influenced the decisions on policies made regarding end-of-life decisions. For instance, there are instances where a patient`s life is ended without significantly determining whether they would have opted for such a cause of action. The Karen Ann Quinlan case of 1976, presents the best example of such a patient who was in a persistent vegetative state ( Lewis, 2013 ). The 22 year old lady had been involved in a car accident and owing to her deteriorating state, her parents opted for passive euthanasia which involved placing her off life support; though the hospital was not willing to do so. The New Jersey Supreme Court, however, later on determined that the treatment could be ended and hence the hospital needed not to have any fear of civil retribution ( Lewis, 2013 ).
Later on in 1983, another young 25 year old patient, Nancy Cruzan got involved in car accident ( Norlander, 2014 ). Her condition showed no room for improvement and hence her parents sought to have the artificial nutrition and hydration terminated, a decision that the hospital was entirely against. Upon moving to the Missouri court, it was determined that the only way that such an action can be taken is if the patient`s parents offered significant evidence that their daughter would have wished for such an action to be taken; something that they did not have at the moment. Nancy`s parents later submitted the evidence leading to her demise. It is hence clear that certain ethical considerations have to be met in order for end-of-life decisions to be made.
Conclusion
End-of-life has developed over the years to accommodate a number of changes in the contemporary world. Initially, termination of life was not allowed unlike currently when many people often opt for their lives to be terminated or their family members make the plea on their behalf. As illustrated above, various regulations also exist requiring people to provide sufficient evidence that the ailing individual would wish for their lives to be terminated. Besides this, nurses are in some instances sanctioned to offer
References
Hebert, K., Moore, H., & Rooney, J. (2011). The nurse advocate in end-of-life care . The Ochsner Journal, 11 (4), 325–329.
Lewis, K. (2013). How nurses can help ease patient transitions to end of life care . Nursing Older People, 25 (8), 22–26.
Norlander, L. (2014). To comfort always: A nurse's guide to end-of-life care (2nd ed.). Indianapolis, IN: Sigma Theta Tau International.
