End of Life Issues
Advance Directives Why do we need an advance directive? Physicians used to subjectively decide for the patient, and the patient did not have autonomy, such as CPR for cardiac arrest. Now this decision making has shifted to the patient. Most family members, having not been in an ICU before, are not prepared to make decisions. Physicians have a sense of whether the patient in the ICU is going to live or die. Typically the family will prolong life until the physician tells them that they don’t think the patient will survive. (Navasky & O’Conner, 2010) A living will can make your preferences known regarding end of life care. Setting up this legal document will speak for you when you are unable to speak for yourself, for example if you are in a coma. These situations can come up at any age. All adults should have an advance directive, which should be clearly written and witnessed. (Sabatino, 2007) A durable power of attorney is not the same as authorizing someone to take care of finances. It is a legal document that allows another individual, your health care proxy, to make medical decisions for you if you are incapacitated. This document goes into effect after the patient become incapacitated, and only pertains to healthcare decisions. (Sabatino, 2007) Euthanasia The word euthanasia is from the Greek word for “good death”. It is defined as the act or practice of ending a person’s life by lethal injection or terminating medical treatment. There are many types of euthanasia-voluntary, active, passive, physician-assisted, suicide, and assisted suicide. Euthanasia can provide relief for the family, and a means to end a patient’s suffering. (Porter, Johnson, & Warren. 2005) Physician-assisted suicide and euthanasia are legal and practice widely in the Netherlands. Oregon has legalized physician-assisted suicide. The Supreme Court has ruled there is