|Type of paper:
|United States Law Philosophy Social issue
Life not given, and at some point in time, every one meant to die. It may be a natural death like dying while asleep or synced death from a fatal accident, a sudden ailment, or a terminal illness that slowly ends one's life. Before the actual death from the latter cause, one may end up in a coma at the intensive care unit. Depending on how severely affected a person is from either the accident, illness, or other related factors, they may or may not recover.
These are the kinds of matters that need a deep understanding before making any decision. It is because the decision made affects another human being, whether they continue living or should lay to rest. Making such a decision requires looking into various aspects of the patient's life. It may revolve around the patient's wishes, the medical bill accruing, the effect of the patient's condition on the family, the chances of the patient's medical history, and so on.
Nevertheless, it is essential to acknowledge the physicians' role in the remnant cycle of the patients. Their role in monitoring the condition of their patients and caring for them is very crucial. Their expansive knowledge in the field becomes more relevant; they know how to deal with each patient and, even at some point, get attached to them. They are then able to relate to them, console, advise, and, if lucky, bring them into acceptance of the situation.
Recently, some states have been allowed to let people decide their fate earlier should anything tragic happen, that could put them at the end of life. Also, a patient could choose his or her fate soon after learning of their situation. Such decisions from a patient depend on pain, their emotional state, their attitude, and the support they get from friends and family. Loneliness and helplessness could also be premeditated factors of the patients.
In California, the citizens are at liberty to use the medicated source of a slow death but only for patients of sound mind. The citizens are enhanced to inform their close friends and family of their wishes, should need to arise. The state has enabled its healthcare system to prescribe ABX2-15 for the aged and those suffering from terminal illnesses. The state is the fifth in the country to be allowed to undertake end of life decisions.
The ethical principles of professionals are very crucial in decision making. The patient makes the final decision based on autonomy. If the physician questions the patient's state of mind, they can ask for help from a third party. It can be considered a violation of the laws of the end of life, but the doctor does this for his patient's well-being. Figure 1 shows the differences between ethics and regulations to gain an understanding of their application to this matter.
This matter has brought up a lot of contemporary issues because, under normal life circumstances, taking away life is taken as murder, a capital offence, and is highly punishable by the law. Initially, if a physician wanted to aid at the end of life, they would be considered to be involved in homicide. Currently, however, the government has permitted the medical personnel to prescribe medicines that quicken death to the patients that are terminally ill. Yet, all this is done by following specific guidelines and conditions.
The issue is regarded as ethical if it is considerate of both the patient and the physiologist. A problem may seem lawful, but it may not be considered ethical. The decision should be able to suit the needs of the patient and, at the same time, not affect the doctor's professionalism. It should note that the clinicians have the right to decide whether they want to be involved in the process. Thus it should not feel like an obligation to the physician.
A case study of the end of life is for an 18-year-old immigrant who just realized she had acute lymphatic leukemia. She did not have insurance and had financial difficulties such that she could not cater for her medical expenses. By the time she was admitted, her health was worse and ended up in the ICU. The nurses realized that she was slowly dying, and many of her organs were failing. They decided to call her family, and only her husband was near since the rest was in her home country.
Her partner mourned and was hopeful she would survive, but she died the next day of a cardiac arrest after numerous attempts at CPR. Ethically, this was all wrong since the physicians could have tried harder to save her life regardless of her financial situation. Asking her partner to decide if they should perform CPR on her would have been tricky since he would have agreed to anything as long as her life spared despite having little or no knowledge of the issue at hand. Such a case reveals how an end of life situation would occur.
Another case study in end-of-life situations is of an 80-year older man diagnosed with pulmonary fibrosis associated with cardiac failure. The chances of him being in his final year are high. He was an active and chronic smoker just recently and had only been cured of tuberculosis four months prior. His kids live miles away with four of his grandchildren. As a retired teacher, he lives alone.
He has been under pain management for a while now. Due to the distance, his family has only seen him twice in three months, and as a result, Tim feels neglected. He suffers from depression, and though he has accepted his soon to be fate, he still wishes he could have more time with his family. Soon after learns about the ABX2-15 and decides the prescription would do to aid a faster death. He opts for home-based care, but his health diminishes with time, and after three consecutive admissions, he passes on.
For those who opt to participate at the end of life process, it is a requirement by the law to carry out the process in a just manner. There is a procedure that the physicians must take while attending to the affected patients. It may include a diagnosis that is already confirmed, and if need be, they can refer to other specialized physicians. The said doctor must be registered and licensed by the Drug Enforcement Administration. They are entitled to advise their patients of their current situation and where necessary even to make them aware of other options like palliative care instead of the end of life medicines.
Before administering the said drugs, the doctor should analyze the mental condition of their patients to determine how they respond to their health. It is essential as the patient may not be in their full state of mind when agreeing to such terms. Some may be mentally ill or depressed and thus end up opting to take the drugs. It should note that the law does not allow a person to choose into such a decision if they are not of legal age. The patient must be of 18 years and above and very susceptible to the fatal illness with probably a life term of fewer than six months.
Also, the doctor should try to determine if their patient understands their prognosis and diagnosis before opting-in taking the drugs. The doctors should discuss the beliefs, the fears, and possibly even hopes of their patients. They should assess how doubtful or accepting the patients are to their condition. The consultation between the doctor and the patient should also involve ways of managing pain and symptoms for the patients. Patients should learn of the advantages of hospice care and palliative care, should they opt to choose from them. Figure 3 illustrates the differences between palliative and end of life (hospice) care.
The patients that opt into taking hospice care are required by law to make requests to their physician twice within the same month orally, but with a time interval of 15 days. It should accompany a written request from the patient to the doctor. The presence of a third party is crucial so that the person acts as the witness. The patient should also be able to self-administer the medication in situations where the doctors may not be within reach.
The patient must also be a resident of California and able to make sound decisions on their own. Their doctor should certify this after a mental assessment of the patient. Their decision to opt-in asking for the aid-in-dying drugs should also not be due to being coerced by others. It should note that no one is allowed to request on behalf of somebody else; only the patient is allowed to make their request known. It means even power of attorney permits a third party to make such a request on behalf of their client, the patient.
It is also a requirement by the law that the patient must be suffering from a terminal illness with a remaining span of about six or fewer months. The diagnosis should be final and incurable according to doctors and with a reasonable assessment of likely die within a few months. The patient should also well inform of their condition by the physicians. Should they feel like they deprived of information, they are at liberty of consultation from other doctors or organizations and even using referrals. Figure 2 shows how laws relate to patients and their physicians at the end of life issues based on the principles and how they applied to the care.
Consent in end of life situations requires prior consideration of matters in depth. Before the physicians can administer the "aid-in-dying" drug, they must first get the patient's approval. It means that the patient should be in a position where they already know of their state of health, have consciously determined what they want freely without influence, willingly present their wish to start on the medication. They understand the consequences of their actions. The patient's mental state of mind should be okay so that their decision will not be void. Otherwise, their request would nullify.
Consent in matters of life and death can only consider being ethical if the patient solely makes the decision. It should be rated based on the expectations of the patient; how realistic their expectations are. They should understand the nature of the treatment and the impact it would have directly and indirectly on them and their loved ones. The patient should be able to voice their wishes clearly and rationally discuss the information they receive to gain more knowledge on the subject.
They should be fully aware of all the possible scenarios in the course of their treatment or lack of treatment. Based on the info availed, they can decide if they can cope and take each day as it comes or if they would instead put an end to their already not-so-long life to be. They should also understand the terms for undertaking the treatment, as stated by the law. However, it should note that the patient equally has the right to refuse to undertake the treatment.
Consent is said to be problematic if the decision to be made by the patient is either unknown, unavailable at the crucial time of need or if the decision is considered void due to various circumstances. Such circumstances include when dealing with minors, patients who have dementia, the mentally ill, the unconscious, and the disoriented old. Their decision to partake treatment is highly questioned and thus may consider being unauthentic.
Those that are lucky to recover fully realize how valuable life is and take advantage of the second chance at life; however, some are not as lucky and, at the end of the day, have limited time. Their survival hangs loosely on a thread as the clock ticks. It is the approaching end of life for them. No one wants to know that they were on the verge of death and that they are so close to death. Therefore such matters would have to be addressed with the utmost consideration.
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