End of Life conversations

Question of Moral Judgment: Advanced Directives

End of Life Conversations

by Ann Christelle Labossiere
Jul 28, 2017


        It becomes a question of moral judgment when an individual is receiving end of life care. How do we know what is best for them in moments in which they face a terminal illness? How can the medical staff act a support system if the patient has an advanced directive, but the family members don’t want to see their loved one go?
        In a podcast on The Cost of Dying & Moral Choices at the End of Life at the Ethics Center and the Commonwealth Club of  Silicon Valley, the audience listens to Lisa Krieger-research reporter for San Jose Mercury News- discuss her father. This was taken place on May 14th, 2013 and the topics discussed are still relatable and will continue to be in later years-morality and death.
        Despite not personally knowing him, the audience learns a great lot about Lisa Krieger’s father- a man who went to Columbia and Oak Ridge, tutored his only child (Lisa)  even when he was abroad-and how his story mirrors the story of many. At 88 years old, Krieger’s father had progressive Alzheimer’s disease. Symptoms of Alzheimer’s is dementia include personality changes and impaired reasoning- according to the accessible Google definition. Alzheimer’s is also described as an “irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and eventually the ability to carry out the simplest tasks,” according to NIA (National Institute of Aging site).
        $25,000. That was the daily charge of her father’s stay at the ICU (Intensive Care Unit) and he remained at the hospital for 10 days. The total bill was $323,000. Her father had sepsis, an extreme condition that “arises when the body's response to infection causes injury to its own tissues and organs.”
       “With advanced dementia, not eating’s pretty normal at the end...but if they can't remember how to swallow..maybe it’s time to start thinking about letting go..” In the midst of her father being in the ICU, the medical staff would bring the feeding tube to the room. Krieger gave an example of how feeding tubes can help prolong life for certain illnesses like esophageal cancer. However, with her father’s situation, she felt that it became a matter of prolonging his death. For reasons of reducing confusions on how a patient would like to take action in a moment where there is an “end-of-life” emergency, there come advanced directives.
        Advanced directive-also known as living wills- can be perceived in many ways depending on one’s beliefs and expectations. These directives give an individual the right to how they want intensive care and even act as a mediator to family’s contentions on what is best for their loved one who is receiving the end of life care. Later on in the podcast, Krieger gives steps on how one can go about establishing their own advance directive as well the importance of having these conversations with families. In looking at a website-Christian Medical & Dental Associations (CMDA)-the pdf gave a guide for a particular audience: Christians. It acted as a guide and source of information regarding how to get an advanced directive, and in a way how this can resolve the tension among family members that are still living and how they can assist you in the ways, one desires. For instance, the topic of DNR-(Do Not Resuscitate) and written order of consent by the patient or Health Care Agent’s consent is very important, for a patient can deny receiving help such as CPR- Cardio-Pulmonary Resuscitation. With the decision to deny any intervention that can help the patient live, the patient has a right to voice their opinions in advance to avoid confusion and to communicate their wishes.
        As a Christian myself, I was pretty shocked by the pdf. I thought it would be greatly stigmatized upon. In the community of being a Christian, I have taken time on the Bible and read many stories on the encounter of human suffering and how inevitable it is. In Matthew 6:34, it says, “Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own.” Now, this is not to say that as Christians we are not entitled to make a plan for ourselves. However, it is with the faith that we believe in God and Christ as Savior that we believe that we should not let fear take over. With a resource like CMDA and growing up in a Haitian community where intensive care is placed upon loved ones who have died-may that be doing their hair, dressing them up formally, cleaning their nails- I am exposed to some realms of approaching loved ones who have passed.
        In an August NY Times article of 2014 Coverage for End-of-Life Talks Gaining Ground, Pam Belluck discusses the end of life discussions between a doctor and patient. The article referenced a study showed that cancer patients “are more likely to receive EOL care that is consistent with their preferences when they have had the opportunity to discuss their wishes for EOL care with a physician." During the time of Belluck's article, it was unclear until the fall what the decision would be in regards to if The Centers for Medicare and Medicaid Services would agree to cover end-of-life discussions (Belluck).
        In the KFF (Kaiser Health site), it has an article 10 FAQs: Medicare’s Role in End-of-Life CareYes from 2016 that answered the question posed back in the article: “For terminally ill Medicare beneficiaries who do not want to pursue curative treatment, Medicare offers a comprehensive hospice benefit covering an array of services, including nursing care, counseling, palliative medications, and up to five days of respite care to assist family caregivers.  Hospice care is most often provided in a patient’s homes.” As a result, we have progressed in terms of our decisions to involve patients and doctors in communicating the way they wish their care to be like as advancement, as reiterated from earlier. 
        In many ways, it can be hard to realize that at one point in life, we will die. However, in many ways, we alleviate the stress in many ways-religious, social, political, economic- by having these EOL discussions.

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