Chronic and terminal illnesses are familiar concepts in the healthcare industry. Different patients have different reactions to diagnoses with chronic and terminal illnesses, which requires the healthcare professionals to be comprehensively prepared to provide relevant care for each patient. Every patient is entitled to an autonomous right, and have the right to choose the type of care that they can accept. Physicians and healthcare professionals are ethically required to honor the rights of the patients while observing dignity and respect of every patient.
When a person is diagnosed with terminal illness, he/she can choose to either receive palliative care or request for Physician-Assisted Suicide, PAS. This paper will analyze and compare the effects of palliative care and PAS during end of life, with the aim of realizing the best care for patients during this period. The analysis will be guided by the PICO Question: In the end of life care patients, what is the effect of palliative care compared to physician assisted suicide in dealing with terminal illness?
End of life care is always a controversial topic for many healthcare facilities, legislators, and relatives of patients, as most patients become incapacitated to decide what is right for them before writing an advanced directive. The involved parties for such patients maul over what would be the best outcome for the patient. Bam and Naidoo (2014) defines palliative care as the active provision of holistic care to patients diagnosed with terminal or chronically progressive illnesses. Palliative care is multidisciplinary and focuses on providing relief from symptoms such as pain in order to improve the quality of life of the patients till their end of life. In addition to relief of pain, palliative care seeks to provide emotional, psychological, social, and spiritual care to patients as requested or as deemed right for the patient.
End of life care requires more than medical care, as such patients can despair on life due to the knowledge that they do not have long to live. Therefore, care givers must affirm the process of death as a normal human experience, which should be embraced with respect and dignity. One aim of palliative care is to help the patients to accept death as a normal process, while at the same time, providing relief from all the distressing symptoms that may reduce the quality of life of an end of life care patient.
Wittenberg-Lyles and Sanchez-Reilly (2008) sought to establish the effects of palliative care on elderly patients diagnosed with advanced cancer. The article argues that providing palliative care to such patients yields more benefits to the patients and their families, as it enhances the quality of life of the patients, improves satisfaction among the family members, and extends timeliness and adequacy of care services to patients. The study also revealed that there is an increased possibility of reduced institutionalization of patients with advanced care if palliative care is introduced early enough.
Palliative care has effects not only on the patients, but also on nurses. The impact of palliative care on nurses enables them to provide better and more relevant care to end of life care patients, as delineated in a study by Bam and Naidoo (2014). In this study, nurses reported enhanced knowledge in providing end of life care to patients with HIV, as the nurses better understood mortality. Consequently, the nurses were more compassionate, and were able to extend the concept of ‘care’ to their patients.
Another option for terminally ill patients is PAS, which is defined as the provision of information and resources by a physician to the patient, with the full knowledge that such resources and information can be used by the patient to end his/her own life (Friend, 2011). In PAS, the physician is responsible for availing all medical alternatives to a patient, and this includes PAS, especially in states that have legalized the practice. Patients who resort to the PAS deem that the benefits of life prolonging treatments do not outweigh the burdens. However, healing still remains the core of the medical profession, and healthcare professionals should pursue this foundation more than they pursue termination of life, even with the permission of the patient.
There is also an argument about the state of mind of terminally ill patients, as this largely contributes to their medical decisions. Some professionals argue that patients diagnosed with terminal illnesses, despite their seemingly sound state of mind, are in a state of grief. A state of grief may lead to tenuous decisions, as the patients are afraid of the prognosis. Although the physicians are mandated to respect the autonomous right of patients, it may not be justifiable to solely regard this right when providing the option of death to a patient. Despite these arguments, there are dire situations that may necessitate PAS. Efforts to improve the life of a terminally ill patient may fail, and denial of PAS may only be adding to the pain and suffering of such patients.
Harris (2014) tells of a 38 year old woman diagnosed with cancer who chose physician assisted suicide as she wasn’t prepared for palliative care and the burden that accompanies such care, which would fall squarely on her husband. The patient is in excessive pain, and has trouble breathing. Although Jolene is entitled to information about PAS, it is unethical of a healthcare profession to initiate the discussion, as this may count as coercion. It is also important that a nurse who is objective, and remains so, provides such information, as personal values and beliefs may impact the kind of information that the care professional gives to the patient. Harris (2014) also suggests a review of all alternatives available to the patient, as the core role of care professionals is to protect the wellbeing of the patient.
Quill (2012) reveals that in his career, he has assisted many patients with PAS. However, he confirms that were there another way, the patients would not have preferred to die via PAS. This is because PAS is suicide, and patients are mostly afraid that they will be misunderstood as suicidal, a demeaning and preposterous term, if they request for PAS. This confirmation sheds a light on the feelings and perspectives of the patients regarding PAS. Quill (2012) affirms that palliative care is, and always should be, the standard care for patients with terminal illnesses.
Friend (2011) argues that although palliative care may fail to improve the quality of life of patients suffering from terminal illnesses, PAS should not be adopted as the moral solution. This is because the relationship between a patient and licensed healthcare professionals is founded by the ethical principle of doing no harm to the patient. Friend, like Quill and Harris, insist on the importance of nurses and other healthcare professionals reviewing their own feelings about PAS, rather than just accepting it as a means of ending pain and suffering from patients. PAS principally remains the decision of an informed patient, and a justifiable reason for the action on the part of the physician.
The increasing acceptance of PAS is a worrying trend, as it may overshadow other options available for the patients. From the analysis, it is evident that palliative care has more positive effects on patients, compared to PAS. although none of the patients who have chosen PAS has told the story, the experience of physicians such as Dr. Quill (2012) show that the patients only lacked an alternative. Additionally, the patients didn’t entertain the idea of being considered suicidal, which strongly indicates negative effects of PAS compared to palliative care.
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