1

End-of-Life

Joseph Morales

California State University, Channel Islands

HLTH 499

Professor Winans

October 3, 2021
 2

End-of-Life

The end-of-life process can be emotionally draining from family members that are in the

process when a loved one is critically ill or is diagnosed with a terminal illness. Family is faced

on deciding if they should start a treatment or pursue end of life measures. Therefore, advance

care directive is recommended but its either people are not informed about or never get the

chance to fill out the paperwork. As a result, in the United States making these kinds of life

decision is based on the individual’s autonomy but the illness makes it to where the patient is

incoherent to make life choices. Furthermore, nurses face challenges based on the care directive

needed to be followed knowing their ethical perspective with burden based on the decisions

made by someone else. In the U.S. treatment can be continued on terminal ill patient’s but

European countries refrain knowing it’s not ethically valid for these patients. Being advanced on

modern medicine technology should not give healthcare the right to keep patients alive knowing

they will be in a comatose state for the rest of their life.

Intensive Care Unit

The path towards end-of-life (EOL) care for the family member can be the most difficult

decisions they will ever make in their lifetime. Family members need to decide on whether their

family is at the stage where it’s time for the to pass away or there being a chance for them to

survive. When a patient is admitted into the intensive care unit (ICU) the care is provided by

advanced technology to provide the best care for them to have a chance in surviving an illness.

But sometimes there is a limit to the care a physician and nurse can provide for the individual to
 3

give them a chance to survive and quality of life. For patients who are not able to communicate

due to illness they are represented by a family who decides the goals for the care.

Towards end-of-life care patients have a variety of options to have a goal towards what

steps to take. The options offered to patient or family members are Terminal, Hospice, and

palliative care. They consist of a life-threatening illness that can control pain, psychological, and

social pain bye nurses and physicians. the main goal for this process is providing quality of life

for the person who will eventually die from a fatal condition. Palliative care is specialized by

medical staff that focuses on relief from the illness by providing comfort care and treatment.

Furthermore, Hospice care is implementation of there not being treatment because death is

expected.

Comatose

Behind the scenes in healthcare not everything is what it seems during the process of the

care provided to a patient. The person can be in the state of comatose where there in a state of

being supported by machine to stay alive. The machines they are supported by a ventilator for

breathing, gastrotomy feed tube for nutrition, and medication. As they continue to stay in this

state the chance gets lower to where they won’t wake up and at all to become independent on

their own. Furthermore, the longer the patients stay in this state begin to develop disease such a

pneumonia and pressure sores. Pneumonia is caused in these patients because of the bacteria that

is in the hospital. Pressure ulcers are common in these patients because of immobility for long

periods of time. They are developed often near sites of bony areas such a tailbone, heels and

hips.
 4

At this time, ethical outcomes of patients Doctors overall take control of the choices to

the outcome and nurses have to follow through by trying to provide the best quality care for the

person. “Perspectives on ethical problems appeared different because doctors bore the burden of

having to make the decisions and write the orders, whereas nurses' burden entailed living with

the decisions made by someone else” Izumi, S., Nagae, H., Sakurai, C., & Imamura, E. 2012.The

core problem doctors and nurses are faced with are suffering causing moral serves to the patient

to reduce suffering. In a study done among seven doctors and fourteen nurses was based on how

they felt towards their moral commitment to patients. This reflected upon acute care setting

enhances towards ethical reasons.

Decision for Family Members

Along with, EOL family members take a huge part because of the outcome decision they

need to make for their family member or loved one. When a person incapacitated to make

decision for their EOL a family member takes the role for the person, In the United States. The

decide on how they will manage the process from it being continued, EOL treatment, initiation,

and withholding. The majority of the time family are faced with not knowing what to do from

there loved one which results in emotionally being overwhelmed by the entire process. The

United States encourages people to have their paperwork on advance care directive to plan help

the family member decide on life-sustaining treatments. When people are alert in on decide on

their own autonomy, but it becomes a difficult issue due to being in a comatose state. This

prevents the individual from communication with family member to assist on deciding life-

sustaining treating. As a result, very little people don’t take the time to complete this

documentation. “Family members may face challenges in obtaining the information needed to
 5

make a good decision or knowing when a decision point is nearing. Without adequate

information from health care providers to inform the decision, families can experience

resentment and emotional burden after a decision is made. Family members also may be

uncertain about the right decision to make, even when there is an ACD in place” Trees, A. R et

al., 2017.

In particular to the EOL care for minority patients they are faced with barriers for the

reason access to receive inadequate care from health care providers. They are ignored in a sense

due to the color of their skin especially when it comes to African American. The Medical Care

has a created an environment where there is mistrust the medical community because of the

disparities they have faced. “It also has been found that older African American women receive

mammographic less often than social economically and demographically matched European

American woman, and that the nonwhite (mostly African American) pneumonia patients were

less frankly admitted to attested care unit than similarly ill and simulate insured European

American patients” Krakauer, E. L., Crenner, C., & Fox, K. 2002. Therefore, African American

individual have list visits to their doctor but end up hospitalized more often than another

ethnicity or race. The challenges Hispanic individuals face once admitted to a trauma center

don’t receive pain medication even though they might have similar injuries as a white individual

who are given medication.

Working as a Certified Nursing Assistant for 6 years opened knowledge and experience.

Although things that would bother others if they would ever step foot in a Skill Nursing Facility

or a Hospital will bring full body chills to their entire bodies. The concerns I have reflecting

when giving care to patents is why are they kept alive for long periods of time when there is no

chance of becoming alert and independent. As they continue to be bedridden these patients can
 6

begin getting wounds or hospital born illnesses. I want others to imagine people by placing

themselves in this position of these patients that are not able to communicate when they have

pain or do not feel well. Nurses can identify pain by face expressions and changes through vital

signs but in a way these leaves patients without justice because the patient is poke, prone,

changed, and bothered throughout the whole day. A study done in six European countries limit

on how they will prolong the life of someone if they know that there is not a chance for them to

be their normal independent self. The country's included, Denmark, Italy, the new Netherlands,

and Belgium. “High-technology treatments, such as respiration therapy, oncotherapy, surgical

interventions, and dialysis, are associated with a greater burden of treatment for patients”

Bosshard, Georg, et al., 2005. Modern technology and medicine are so advanced that it can keep

people alive, but first physicians refrain from these advancements to prolong life knowing it will

now be ethical for the individual.

Conclusion

The end-of-life process for a family member can take a toll on their mental health

because no one would ever think they we be in the position. Deciding if they should try

lifesaving treatments or let go. One never knows if they are going to be independent after being

diagnosed with a terminal illness but most of the times there is a low chance of them being health

again. The United States wants a person to rely on their own autonomy yet many of these

patients tend to be unresponsive or alert. Therefore, the U.S. recommends to complete paperwork

such as advance directives for family, so the patients family members are not left with burden

and guilt deciding on what’s right. If family members accepted that their family faith, then the

next step would be placing them in hospice or palliative care. When having a patient to be placed
 7

on treatments nurses have been face with disagreement on the choice because the patient is

suffering. Sometimes when we think what is right for our family but it’s not always so we must

plan and educate of these difficult choices.

 8

References

Aldridge, M. D., & Kelley, A. S. (2015). The myth regarding the high cost of end-of-life
care. American journal of public health, 105(12), 2411-2415.

Bosshard, G., Nilstun, T., Bilsen, J., Norup, M., Miccinesi, G., Van Delden, J. J., ... & van der
Heide, A. (2005). Forgoing treatment at the end of life in 6 European
countries. Archives of Internal Medicine, 165(4), 401-407.

Curtis, J. R., & Vincent, J. L. (2010). Ethics and end-of-life care for adults in the intensive care
unit. The lancet, 376(9749), 1347-1353.

Izumi, S., Nagae, H., Sakurai, C., & Imamura, E. (2012). Defining end-of-life care from
perspectives of nursing ethics. Nursing ethics, 19(5), 608-618.

Krakauer, E.L., Crenner, C., & Fox, k. (2002). Barriers to optimum end-of-life care for minority
patients. Journal of the America Geriatrics Society, 50(1), 182-190

Trees, A. R., Ohs, J. E., & Murray, M. C. (2017). Family communication about end-of-life
decisions and the enactment of the decision-maker role. Behavioral Sciences, 7(2), 36.