Science and medical technology advancements
Science and medical technology advancements have resulted in a shift in the care of dying patients from family members to medical practitioners. When a patient is nearing the end of his or her life, a nurse works as an advocate (Berlinger et al., 2013). A nurse helps the patient manage pain and make decisions to ensure optimal patient care at the end-of-life stage. The patient-nurse relationship is the foundation of a nurse's function as an advocate. The nurse must communicate with the patient on a personal level, which allows the nurse to understand the patient's strengths and beliefs and intervene accordingly. Patients at the end-of-life stage are usually vulnerable where they cannot speak for themselves thus the need for advocacy.
The role of a nurse as a gatekeeper
A nurse acts as the gatekeeper to crucial information, and the nurses shoulder the responsibility of breaking sensitive information, such as the diagnosis of a chronic condition to a patient. A nurse has to be considerate of the needs of the patient and family to ensure that such information is received well. A nurse also translates medical information in a manner that the patient and family can understand. A doctor may not always be clear when the family and patient are consulting. Thus, it is the role of a nurse to explain information received from a doctor to foster better end of life decisions (Brinkman-Stoppelenburg et al., 2014).
The Patient Self-Determination Act of 1991
The Patient Self-Determination Act of 1991 arguably generated end-of-life health care policies (Smith, 2012). The Act required organizations participating in the Medicare program to notify patients of their rights to file an advance directive about the treatment they would like to receive. The Act intended to give patients increased control over the treatment they received during their end-of-life phase. The Act has been altered to recognize the capability of a surrogate to fill the advance directive about treatment for a patient who cannot make the requisite decisions (Brinkman-Stoppelenburg et al., 2014). The legislation was not an outcome of a specific case but rather a sequence of medical cases when patients and families filled cases for not being allowed to make the end of life care decisions. The courts increasingly appreciated the constitutional rights of patients to reject life-prolonging decisions which led to the implementation of the Act.
Primary policies relating to end-of-life health care decisions
One of the primary policies relating to the end-of-life health care decisions is that a health professional should inform the patient about the need to fill an advance directive about treatment (Berlinger et al., 2013). Another policy is that if a patient is incapacitated to make the decision and fill the advance directive, their surrogate can fill the form on their behalf (Berlinger et al., 2013). The health information should collaborate with the patient or their surrogate to provide adequate information about diagnosis results as well as various treatments available. The end-of-life decision regarding life-prolonging treatment made by the patient or their alternate is binding. These policies limit treatment decisions. For instance, the health professional is compelled to follow the directive by the patient or their surrogate even if other better life-prolonging treatments are available.
Effect of end-of-life regulations on patient outcomes
End-of-life regulations have a positive or adverse effect on the patient outcome which is largely dependent on the decision made by a patient or their outcome (Smith, 2012). A nurse collaborates with a nurse to explore a variety of life-prolonging treatments that are available. The primary goal of a nurse dealing with a patient at the end-of-life phase stage is to reduce pain and foster a dignified dying process. On the one hand, if a patient or his surrogate embraces the life-prolonging treatment option presented by a nurse, the patient can expect a better outcome. This also fosters a good relationship between the nurse and patient. On the other hand, if the patient or the surrogate ignores the life-prolonging treatment presented by the patient and make an uninformed decision, the patient can expect a bad outcome as well as a strained relationship between the nurse and the patient.
Ethical considerations in end-of-life decisions
Autonomous decision making is a key ethical consideration that has influenced policy decisions regarding end of life decisions (Smith, 2012). The constitution mandates patients receiving the end-of-life care decision to make a decision about the treatment they want to receive. However, a nurse may not always act according to the directive by the patient or surrogate particularly when the nurse can prove that following the directives of the patients will do more harm than good. The role of the physician is another key ethical consideration (Brinkman-Stoppelenburg et al., 2014). A physician is required to inform the patient about life-prolonging treatments that are available. Although the decision by the patient about the end-of-life care they would like to receive is binding, a nurse may choose to disobey the directive by the patient especially when doing that would lead to unnecessary wastage of resources.
References
Berlinger, N., Jennings, B., & Wolf, S. M. (2013). The Hastings Center guidelines for decisions on life-sustaining treatment and care near the end of life. Oxford Scholarship Online. DOI:10.1093/acprof:oso/9780199974566.001.0001
Brinkman-Stoppelenburg, A., Rietjens, J. A., & van der Heide, A. (2014). The effects of advance care planning on end-of-life care: a systematic review. Palliative Medicine, 28(8), 1000-1025.
Smith, S. W. (2012). End-of-life decisions in medical care: Principles and policies for regulating the dying process. Cambridge: Cambridge University Press.
