Please read through bullet points, their two assignments:
Based on the End of Life slides (i’ve attached it below ), I want you to reflect on
YOUR options.
What you will need to do this week is relatively simple:
Read
the short article below
Re-review
the slides from last week
Complete
an advanced directive for the state in which you are a permanent
resident…including figuring out who you would name as your health care
advocate
Tell
your advocate that you are naming them; even though this is merely
“homework,” you may be surprised by the conversation you have
with them!
Upload
your Advance Directive under “assignments” (This way other
students will not be privy to your choices).
Then
start a new paper and answer my questions:
Was it
difficult to complete your AD?
Who
did you ask to be your health-care advocate? Why?
Who
did you NOT want to be your health-care advocate? Why? =)
What
happened when you asked your advocate to participate?
http://articles.latimes.com/2009/jul/26/opinion/oe-welsh26
end_of_life_issues_1_.ppt
Unformatted Attachment Preview
End-of-Life Issues and Decisions
FROM DESCRPTION
TO DECISION MAKING
Since death will certainly happen, we should think
about some end-of-life issue and decisions.
Much depends on the adequacy of communication
among health care professionals, terminally ill patients,
and their families.
WHO SHOULD PARTICIPATE
IN END-OF-LIFE DECISIONS?
The idea that all individuals should make decisions for
themselves has a lot of appeal in societies that value
individual personality and achievement.
Not all cultures share that view – in some cultures the
family is the center of life, and some cultures deeply value
respect for the past.
THE LIVING WILL AND ITS IMPACT
Advance directives are instructions for actions to be
taken in the future if certain events occur and we
are unable to speak for ourselves at the time.
• The living will was the first advance directive
to receive general attention in the U.S.
• First introduced in 1968 by a nonprofit
organization
• Proved to have limited effectiveness, as lack of
specificity made it difficult for physicians to
respond, and it might not come to the
attention of health care personnel when
needed
RIGHT-TO-DIE DECISIONS
THAT WE CAN MAKE
From Living Will
to Patient Self-Determination Act
The law recognizes a mentally competent adult’s right to
refuse life support procedures.
Individuals are entitled to select representatives who will
see that the advance directive is respected if they are
unable to act in their own behalf.
Advanced Medical Directives:
What Should We Do?
Facts about advance directives (Sabatino (2005):
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They are legal in every state
One that is legal in one state is generally legal in all states
Can change the wording of preprinted forms
A lawyer is not required to make it a legal document
It doesn’t restrict treatment efforts within accepted medical
standards; allows for pain control and comfort care
Health care providers are legally obligated to follow it
With and Without an Advance Directive
Teno, et al. (2007) examined the role of advance
directives more than a decade after the SUPPORT
study and the introduction of the Patient SelfDetermination Act.
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About 70% of people had an advance directive
Those who died in a hospital were least likely to
have an advance directive
Two clear differences between those who had an AD and
those who didn’t during their end-of-life period:
Fewer people with an AD were on respirators
Physician communication with patient and family was
perceived as more problematic when no AD had been
prepared
Informed Consent and Advance Directives:
How Effective?
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Patients are often too rushed to make an informed
consent decision
Many physicians continue to ignore patients’ stated
wishes
Communication among patient, doctor, and family
remains limited
People often have difficulty making decisions as health
and cognitive functioning declines
A RIGHT NOT TO DIE?
THE CRYONICS ALTERNATIVE
Available since 1967
Choosing to have your certified dead body placed in
a hypothermic condition for the possibility of
resuscitation at a later time
First person to chose a cryonic alternative was a
psychologist, Dr. James H. Bedford
A Longer Life? Historical Background
The desire to extend our lives is one of the most enduring
themes in human history.
In pretechnical times it was attempted through physical
ordeals, magical spells, secret rituals, and experiments
with a variety of substances and concoctions.
We are now on the cusp on genetic/stem cell research
that might or might not be successful.
Rationale and Method
Advocates of cryonics believe it is possible to maintain
“deceased” people at very low temperatures for long
periods of time.
Eventually medical breakthroughs will cure the
conditions that led to their “death” and the “deceased”
will be resuscitated.
Heads of Stone:
A Radical New Development
New methods have increased effectiveness of the
cryoprotectants to prevent formation of crystals as a
result of freezing
Two major changes:
Neural (head-only) preservation has replaced wholebody preservation
Cooled tissues are vitrified (transformed into a stonelike substance)
More Questions
Should we regard cryostasis:
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As body preservation, like mummification?
•
As body disposal?
•
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As an affront to God and Nature or just one more lifeprolongation effort?
As a new chapter in the ancient mythology of journeys
of the dead?
As a fantasy addition to the category of “sleepers” who
are neither living nor dead in traditional terms?
ORGAN DONATION
Kidneys and livers are the most needed
Restraining influences on the number of successful
transplantations:
• Willingness of people to donate
• Condition of the donated organs
• Biological match between donor and recipient
• Overall condition of the recipient
• Expense and timely delivery
Approximately 7,000 people donate organs while they
are still alive (such as donating a kidney)
• Victims of fatal motor vehicle accidents are one of the
most available sources
• About 75,000 people are on the waiting list is the
U.S. at any given time
• Demand and short supply creates:
• Discrimination
• Conflict
• Illegal sales of organs to affluent clients
•
Competition, Tension, Controversy
Should an available organ go to the person who is
in the most need and has the highest probability of
surviving with it – or to a person who resides in the
local area from which the donation was received?
Some potential recipients face discrimination
(ethnicity or race?).
Disadvantaged people may be selling their organs for
use by those more affluent.
The relationship between organ donation and the
diagnosis of brain death has been subject of concern for
years.
Would the pressure for quick harvesting of organs
lead to premature certification of death?
Becoming a Donor
It is useful to think ahead of time about organ
donation.
Donate all organs or tissues, or exclude some?
Donate for therapy, education, or research?
FUNERAL-RELATED DECISIONS
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Funeral homes are required to provide a price list
Do thorough comparison shopping
Be aware of additional charges for additional services
and products
Do not hesitate to inquire about simple and immediate
burials or about cremation
The most expensive item in a traditional funeral is the
casket
Use good judgment to resist services or products that
your family really doesn’t want
A Perspective on End-of-Life Decisions
The new social and medical climate for end-of-life
decisions favors strengthened participation,
communication, and patients’ rights.
More people are concerned about making end-oflife decisions that respect patient and family
wishes, but how to do this in an effective and
timely manner is a challenge that still must be
addressed.
…
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