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Approaching death: A literature review on end-of-life care

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Katie S.
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  1. Introduction.
  2. Literature review.
  3. End of life care and the law.
  4. Clinical perceptions and liability concerns.
  5. Proposed solutions.

Before the 1950's many a lot of people died at home with the family around. They often died quickly of illnesses such as influenza, measles or scarlet fever. Today, as medical technology creates more and more tools and medicines to prolong lives, human beings are faced with the difficult process of living with chronic diseases. Currently, many patients and their families are questioning the belief that a longer life necessarily equates with to a higher quality of life. Instead of embracing medical technology that could forestall death, some patients have begun to change the focus onto the quality of their own deaths. Studies show that the majority of human beings will die from the degenerating consequences of chronic disease. This inevitable dying process, by virtue of significant advances in medical technology, can be prolonged for greater periods than in our recent human past. However, the quality of this final phase of life is now a widespread, publicly voiced concern. Planning for end-of-life care is an important social, legal, and ethical issue.

[...] (Waters 1999 107-17) In regard to end-of-life care and a patient wanting to take his/her own life, data shows that excruciating pain is not the first motive for patients who want assisted suicide. Reasons include many nonphysical symptoms such as ?loss of person-hood, discomfort other than pain, loss of dignity, concern about loss of control, loss of meaning in life, being a burden, and dependency.? (Back, Wallace, Starks, & Pearlman, 1996; Canetto & Hollenshead, 1999; Chin, Hedberg, Higginson, & Fleming, 1999; Cohen, Fihn, Boyko, & Jonsen, 1994; Coombs Lee & Werth, in press; Ganzini et al., 2000; Sullivan et al., 2000a, Wilson, Viola, Scott, & Chater, 1998). [...]


[...] End-of-life care also demands a nurse's full attention for pain and symptom management, communication with the patient and family, fulfilling the patient's physical, spiritual, and psychosocial needs of the patient. (Pochard 2001 1893) Other means of improving end-of-life care include routine documentation of assessment, interventions, and outcomes, as well as improvement in communication between clinicians, patients, and families. Azoulay et al. found that more than 50% of ICU patient's families did not understand the diagnosis, prognosis, and/or treatment after a discussion with the physician. [...]


[...] Gender and physician-assisted suicide: An analysis of the Kevorkian cases, 1990-1997. Omega 165-208. Ciccarello, Gail P. RN, MS. Strategies to Improve End-of-life Care in the Intensive Care Unit. Dimensions of Critical Care Nursing. 22(5):216-222, September/October 2003. Field, M. J., & Cassel, C. K. (Eds.). (1997). Approaching death: Improving care at the end-of-life. Washington, DC: National Academy Press. Grisso, T. (1994). Clinical assessment for legal competence of older adults. In M. Storandt & G. VandenBos (Eds.), Neuropsychological assessment of dementia and depression in older adults: A clinician's guide (pp. [...]

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