Running head: END OF LIFE ISSUES

End of Life Issues

Student’s Name

Institutional Affiliation
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End of Life Issues

The fear of death and the mysteries involved at the end of life are difficult for every

individual that makes it a social taboo to make considerable evaluations and considerations.

Family, friends and loved ones make leave little room for people who are going through life-

threatening situations to make fantasies on their death. The thought of death is often shut down

aggressively and more positive and hopeful ideas recommended handsomely. Most individuals in

life threating conditions think about what will befall them after they die and the pain of leaving

their loved ones behind. Elderly people at the end of life care experience a lot of loneliness and

distress during their final days which gives a lot of challenges to their family and clinicians. This

essay discusses some of the issues experienced by patients in end of life facilities as well as their

families and hospital personnel.

Patients who are nearing their death are often predisposed to significant challenges that

include pain, emotional and psychological distress, depression, hopelessness, and despair (Daniel

C. McFarland, 2019). Most of them are elderly with terminal illnesses and whose bodies react

sensitively to drugs due to low immunity. The communication of serious information that can be

termed as bad news is one of the challenges that doctors and caregivers face in the course of their

work. It is therefore uncommon for doctors and health professionals to skew the reality of a life-

threatening condition by concealing the seriousness of an illness. Research has shown that the

culture and norms of the larger population affect the series of events and attitudes in a hospital

environment towards such disclosures that might be considered damaging (Anguiano, Mayer,

Piven, & Rosenstein, 2012). It is therefore considered callous, impolite and unprofessional to

break the news directly to the patients. Contrastingly, most western societies have shifted from
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this practice to give patients more decision-making powers concerning their health and

treatment.

End-of-life conversations between individuals and their families are recommended to

allow both parties to make plans and preparations for the inevitable. According to Searight &

Gafford (2005), healthcare professionals ought to create a conducive environment for diverse

ethnicities by adjusting to their cultural preferences and norms rather than sticking to the

standard guidelines. The standard patient-based approach for communication and decision

making can be overridden when dealing with cultures that prioritize patient well-being by

withholding certain announcements. Patients have little or no decision-making capabilities in the

family-based structures and functions.

Research surveys have indicated that twenty percent of the United States population has

advance directives in place. Minority black, Hispanic and Asian communicates that constitute a

third of the population have low rates of advance directives compared to the Caucasian

counterparts (O’Shea et al., 2002). Most of these patients from these communities prefer their

family members as recipients of medical details on their health and are therefore unlikely to

write advance directives. Patients from minority communities with a history of discrimination

may also have trust issues when dealing with doctors and caregivers from a different ethnicity

(Searight & Gafford, 2005).

Healthcare professionals can identify and appreciate these diversities when dealing with

patients and try to override the standard practices. It is common to ask the patient for their

preferred channel of communication and decision making. On special occasions, patients may

request nondisclosure concerning their health and severity of illnesses which is contrary to

standard practice in western civilization. A conducive parentship and relationship between the
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medical practitioners, patients, and the family members are crucial in the success of the treatment

process. Respecting these cultural preferences on decision-making, disclosure and

communication may give crucial insights into the values and cultural dynamics.

Pain in the physical, psychological and emotional form is one of the characteristics that

most end-of-life situations are common off. Most patients under life-threatening and long-term

illnesses experience a lot of pain which reduces the quality of life. Fifty to ninety percent of

cancer patients are the most vulnerable to physical pain and emotional distress during the

treatment period despite the availability of advanced analgesic medication. Elderly patients may

fail to report physical pain as they consider it to be age-related. Analgesic medication reduces

physical pain in 90% of cancer patients but the fear of progressive pain is common with freedom

from the pain being prevalent (Daniel C. McFarland, 2019).

Research studies have indicated that sixty percent of cancer patients go through

depression during the course of their treatment with fifty percent being diagnosed by psychiatric

disorders (O’Shea et al., 2002). Forty percent of patients with terminal illnesses including cancer

and HIV/AIDS also experience depression and suicidal tendencies. Lack of training among

physicians and caregivers increases the risk of suicide among cancer patients within six months

of diagnosis. Multiple strategies of detecting depression and psychological distress are required

for early identification of patients at higher risk of suicide.

Cancer diagnoses, the extent of pain and physical distress develops into a risk factor for

emotional and psychosocial distress in the form of depression and suicidal tendencies. The

thoughts of suicide as the only solution to the increasing pain among cancer patients. A research

study conducted between 1983 and 1993 in South Florida indicated that 3% of the male suicide

incidences involved prostate cancer patients (Walker et al., 2008). Suicide rates twice were
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higher among cancer patients than those of the general population. Older cancer patients above

the age of sixty-five have higher suicide rates compared to younger patients. Elderly men of

eighty years and above have the highest suicide rates as well as those with one year of diagnosis.

The diversity in the general population concerning race and ethnic and the respective

variations in the cultural norms deal a huge challenge to family caregivers. The variations in the

mode of communication and the process for decision-making among minority communities are

more significant in end-of-life care. Legal requirements as well as the consumer movement

reduces the powers of physicians and family members and go ahead to dictate that the patents be

maximumly advised on the treatment process (Woo, Maytal, & Stern, 2006). This does not,

however, go well with most African and Asian family members who choose to use lighter words

such as “blood disease” to describe rather serious diagnoses such as cancer. Indian and Hispanic

communities may completely keep their family members unawares of terminal illnesses to

protect them. Such communities believe in protecting patients from shock and perceive patient

autonomy as solitary and disassociating.

Patients suffering from terminal illnesses can take a step to prepare themselves and their

families by writing a will to provide directions after departure. A patient can write a living will

that will state their preferred treatment, action and inaction in the event of severe incapacitation.

A living will contain information on what you may want to be done or not such as the use of a

feeding tube when feeding is not possible. The patients may also opt for non-resuscitation during

an acute breathing stoppage in a Do-Not-Resuscitate (DNR) order which is attached to the

medical files. A durable medical power of attorney may also be used to select an individual who

will make medical decisions on the patient’s behalf in the case where their condition worsens.
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This is a recommended step especially when the patient has low chances of regaining

physical strength. A will gives an individual the power to communicate directives that have legal

The studies have shown that end-of-life is a painful process that most individuals and their

families go through. These issues may pose dilemmas to physicians when ethical standards and

practices are tested. There are more tensions involved when patients are on the verge of dying

due to the burdens involved. Most non-western emphasize beneficence to reduce psychological

distress to the patient. As much as patent autonomy is encouraged as standard practice, the role

of the family may override similar approaches not only in minority communities thus posing

dilemmas to physicians. The end-of-life issues have variations and are much dependent on

diversity in ethnic composition. Healthcare facilities can derive more knowledge by undertaking

deeper research on the effects of culture and the desires of patents during treatment. It is

recommendable for hospital facilities and nursing homes to offer psychological support to

patents and their families during their end-of-life period.

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References

Anguiano, L., Mayer, D. K., Piven, M. L., & Rosenstein, D. (2012). A literature review

of suicide in cancer patients. Cancer Nursing, 35(4), E14–E26.

Daniel C. McFarland, D. O. (2019, June 19). Suicide in Patients With Cancer: Identifying

the Risk Factors.

O’Shea, E. M., Lintz, K. C., Penson, R. T., Seiden, M. V., Chabner, B. A., & Lynch, T. J.

(2002). A Staff Dialogue on Caring for a Cancer Patient Who Commits Suicide:

Psychosocial Issues Faced by Patients, Their Families, and Caregivers. The Oncologist,

7(Supplement 2), 30–35.

Searight, H. R., & Gafford, J. (2005). Cultural diversity at the end of life: Issues and

guidelines for family physicians. American Family Physician, 71(3).

Walker, J., Waters, R. A., Murray, G., Swanson, H., Hibberd, C. J., Rush, R. W., …

Wall, L. R. (2008). Better off dead: Suicidal thoughts in cancer patients. J Clin Oncol,

26(29), 4725–4730.

Woo, J. A., Maytal, G., & Stern, T. A. (2006). Clinical Challenges to the Delivery of

End-of-Life Care. Primary Care Companion to The Journal of Clinical Psychiatry, 8(6),

367–372.