Textbook Notes (362,734)
Canada (158,032)
Psychology (3,256)
PSYC 3570 (66)
Chapter 6

Chapter 6

7 Pages
Unlock Document

University of Guelph
PSYC 3570
Erin Allard

Chapter 6: End-of-life Issues and Decisions From description to decision making - the end of life decision depends much on the adequacy of communication among health care professionals, terminally ill patients and their fmailies Who should participate in end of life decisions? - you and I - life support systems and the emergence of the hospice care movement - people are being offered options of increased control in the last few days of their life - living wills and advance directives have an influence - ideally, the person who’s life is coming to an end and all family members would develop a shared understanding – “this is what would be best, this is what would be right for all of us” - local hospital policy and practice has much to do with use of restraints, as do staffing patterns and patient characteristics such as advanced age, presence of invasive devices and cognitive impairment - some people find decision making stressful - increased emphasis on individual autonomy – the idea that all individuals should make their own decisions - people can do little to alter their fate – its in the hands of the gods The living will and its impact  see box 6-1 (p173) - Advance directives are instructions for actions to be taken in the future if we are not able to speak for ourselves at the time - It was the first advance directive to receive general attention in the US - Introduced in 1968 by a nonprofit organization that was ahead of its time in educating public and professionals about end of life options - The living will did stimulate awareness of death related issues - Communication increased between somewhat between individuals and their families, physicians, nurses, ministers, lawyers - 1/5 people have actually completed a living will - the living will proved to have limited effectiveness o lack of specificity made it difficult for physicians to respond o could be difficult to honor the patients wishes - the fact that a person had completed a living will did not guarantee that it would come to the attention of physicians and other health care personnel when it really counted - newer types of advance directives have attempted to provide more specific guidance to care providers and to integrate the info more securely in health care systems Right-to-die decisions that we can make - the right to refuse treatment gained support as courts upheld the principle of informed consent which required that in all situations patients receive adequate info about the nature of the proceduresand the potential risks as well as benefits o no longer a process limited to life-threatened or terminally ill individuals From living will to patient self-determination act - state legislatures hesitated then complied with the public’s request to place a legal foundation under the living will - every state has passed a “natural death act” (also known as “death with dignity” and “living will acts”) - two significant transfers of power from the state to the individual and embodied in these measures o the law recognizes a mentally competent adult’s right to refuse life support procedures (such as machines to assist respiration and circulaton) o individuals are entitled to select representatives who will see that their instructions are carried out if the individuals is not able to do so. A patient who can no longer speak, for example, should be able to count upon his or her appointed health care agent to safeguard the terms of the advance directive. These agents are often known as health care proxies. The responsibility assigned to this person is usually known as durable power of attorney for health care. It is not required, however, that the agents or proxy actually may be an attorney. - These new laws did not guarantee that the intentions would be respected in practice – physicians and hospital administrators were not accustomed to having patients tell them what they could and could not do - There was also a problem of integrating an advance directive into the health care communication system o Where should the document itself be located? o How many copies should be made? o How can patients be sure that their living wills will actually be looked at when the time comes? - Many people do not complete advance directives (including health care professionals) - Members of ethnic groups with a tendency to distrust the health care system and a relectance to disclose their feelings to strangers have a low rate of participation in the advance directive process - Cultural traditions of avoiding discussion of death and dying also contribute to this reluctance - People with deicisional incapacity often have difficulty in comprehending advance directives and do not participate in the process o There are now substitutions – oral statements instead of written directives - We need to take responsibility to make and communicate our own deicisons in the clearest possible manner if we expect others to take responsibility fo respecting these deiscions College students’ attitudes toward end-of-life issues  see table 6-2 - most of the respondents did choose one or more of the life-sustaining options - major surgery – most familiar of the choices – the choice most frequently made - there were no significant differences in choices made by women and men - differences in relation to ethnic background o African americans (72%) were the most likely to request life sustaining measures in general and least likely to ask for a DNR (do not resuscitate) o Hispanics (47%) were the least likely to request life sustaining measures with whites (59%) in the middle o Atheists were least likely to request a DNR order o Small differences in life-sustaining option choices among Catholics, Jews and Protestants - African americans tend to receive less intense medical care than whites and tend to be more negatively stereotyped than other patients - Students of nursing were the most reluctant to accept life-prolonging treatments and the most supportive of DNR orders Advance medical directives: what should we do? - many people think it’s a good idea, but few have actually taken this step - sometimes the patient and the family must take the initiative to encourage health care personnel to discuss end-of-life experiences with them - our first decisive step should be the selection of a health care proxy – a person with the ability to represent our wished and see that they are fulfilled if we cannot do so ourselves - the next formal step is the completion of the advance directive itself The combined advance directive - the CAD is more comphrensive than previously available - provides the opportunity for people to consider the full range of end-of-life options and share their questions and veiws with their families, friends and professional service providers - complete form with directions is available as a download - there are 5 sections: o select an agent and alternative for making health care dicisions if the situation should arise o treatment wishes – preferences for accepting or stopping treatment to keep ne alive under certain circumstances o organ donation o “my wishes for disposition of my remains after my death” o “signed declaration of wishes” – people and locations where this document could be found With and without an advance directive - the SUPPORT study delivered
More Less

Related notes for PSYC 3570

Log In


Don't have an account?

Join OneClass

Access over 10 million pages of study
documents for 1.3 million courses.

Sign up

Join to view


By registering, I agree to the Terms and Privacy Policies
Already have an account?
Just a few more details

So we can recommend you notes for your school.

Reset Password

Please enter below the email address you registered with and we will send you a link to reset your password.

Add your courses

Get notes from the top students in your class.