In the book entitled “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life (2015)”, the authors noted that death is not strictly a medical event. Instead, it harmonizes the social, psychological, and spiritual aspects of life. Thus, making people aware of the need to harmonize all of these dimensions to ensure that the patients who were nearing their death can have access to compassionate, high-quality, evidence-based care, consistent with their final requests. With all the debates on euthanasia, human rights, and professional accountability, the public’s attention shifts their focus on the routine of limiting curative treatment among terminal patients during the last six months of life. The only problem with this scenario is the accuracy of predicting the exact time of the patient’s death to qualify this practice acceptable. This paper would like to review the pros and cons of the routine of limiting curative treatment among terminal patients during the last six months of life.
Differentiating Curative versus Palliative Care
In nursing, there are two approaches by which nurses treat and care for their patients—the curative and the palliative approach. Each approach has different sets of goals and purpose. For curative care, the goal is to assist patients to recovery and restore them back to health (Lee, Vargas & Ennis, 2008). However, palliative care is a type of treatment or care extended to patients who are suffering from terminal illness. The goal of palliative care is no longer restoring the patient back to health but improving the quality of life for patients during their last days of life (Kavalieratos et al., 2016). In other words, a palliative care nurse has the goal of giving terminal patients the ability and opportunity to die with dignity (The Institute of Medicine, 2015). Given the differences between these two approaches, it becomes obvious that each treatment plan targets a specific type of patient. For curative care, it is commonly applied to patients who are receiving treatment for the purpose of being restored back to life prior to the illness. On the other hand, palliative care is usually given to patients who are terminally ill and are awaiting their death.
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Despite the differences in goals and purpose, there is a common ground where these two approaches meet—improving the patient’s quality of life at different stages of their lives. Patients who are diagnosed with a terminal illness does not have to live a miserable life. Nevertheless, terminally ill patients cannot help but feel depressed, hopeless and miserable. Several studies expound on the emotions and views of individuals with terminal illness. In most of these studies, patients expressed their fear, their doubts, and their worries. Patients who are at the prime of their life find it more difficult to accept a terminal diagnosis. Not only does the diagnosis prevent them from doing what they have always been doing, but because of the diagnosis many of them become limited in the things they do. Furthermore, the financial burden of treatment on top of the patient’s limited ability to work becomes bothersome for them.
At some point, trying to reverse the diagnosis by submitting to aggressive curative treatment becomes impractical. This is the time when the members of the medical team would advise the patient and their families that aggressive treatment no longer works and present them with options. This is often one of the most difficult responsibility that the medical professionals have to confront. One of the options given is limiting the curative treatment especially when such treatment has adverse side effects just like chemotherapy.
Limiting Curative Treatment in the Last 6 Months of Life
The responsibility of the medical team is to provide the best possible care for patients regardless of race, gender, age, and other variables. However, there comes a point when the best possible care is to simply allow the person to die with dignity. There had been many talks about the patient’s options under these conditions. Critics of passive and active euthanasia argue that dying is not a decision that can be made by the patient, the families nor the medical professional. However, this has not been the first time that society heard news about request to withhold or limit curative treatment to allow the patient to die.
In an article entitled, “No 6-Month Limit on Compassionate Care (2007)” the author talks about pediatric patients who are confronted with terminal illness. On top of curative and palliative care, the author discussed compassionate care. Empathy is an important value in the medical profession. This allows nurse, doctors and other health care professions to understand the feelings of their patients by allowing themselves to share the patient’s thoughts about death and dying. People should understand that while they rationalize about the religious and moral aspects of passive and active euthanasia, they are not in the position to dictate the patient’s emotions. Critics would argue that patients who request to die are not in a sound mental state and could probably be influenced by medication. Some argues that religious aspect of life suggesting that death is a decision that only God can make. However, theses critics are not aware of what patients and their families had to go through—physically, emotionally, psychologically, and financially. Furthermore, some of the curative treatments for terminally ill patients can be quit aggressive that it often makes them feel miserable.
References
Bates, B. (2007). No 6-Month Limit on Compassionate Care. Caring For The Ages, 8(3), 22-23. doi: 10.1016/s1526-4114(07)60070-5
Kavalieratos, D., Corbelli, J., Zhang, D., Dionne-Odom, J., Ernecoff, N., & Hanmer, J. et al. (2016). Association Between Palliative Care and Patient and Caregiver Outcomes. JAMA, 316(20), 2104. doi: 10.1001/jama.2016.16840
Lee, C., Vargas, M., & Ennis, W. (2008). Transitioning Care from Curative to Palliative Does not Mean Abandoning Advanced Wound Care: Experiences from an Advanced SubAcute Wound Care Unit. Wound Repair and Regeneration, 13(2), A28-A48. doi: 10.1111/j.1067-1927.2005.130216d.x
The National Academies Press. (2015). Dying in America. Washington, D.C.
