Is a patient just the individual or the individual in a community/family? Who should have decision-making powers, especially in end-of-life situations?
The patient is an individual. And has every right to be treated as an individual until the very end of life. Unless unable to answer for themselves, due to coma or a serious change in mental status, a patient has every right to make their own decisions about the end of their life. The family makes the situation tricky in some cases because they want to be able to spend more time with that person, but in the end if that person is ready to die, they have every right to refuse treatment. We recently had a situation like this in our family where my Great-Uncle was diagnosed with a very bad infection... he was almost 80 and the only treatment was to amputate his entire leg. He did not want to life the rest of his life in a wheel chair and in major pain after surgery, so he decided to not forgo the surgery. His children were very upset with him that he did not want to continue and fight, but it was his choice. Patient autonomy is very important for a nurse, and any other medical professional to be conciderate of. It is the patients own choice to decide what they want to do with their life.
The patient is an individual whether they are conscious or not, separate from the family. As far as who should have decision making powers at end of life depends on the level of consciousness of the patient. If the patient is able, they should be the one making the decisions, and if not that power should obviously fall to the family. However, even in the optimal scenario where the patient is fully aware the patient and the family should discuss what they think is the best course of action as far as treatment because what affects the patient also affects the family. For instance, if a certain treatment will put the patient through a lot of pain with varied results it is important for the patient to discuss whether or not to go ahead with the procedure with their family because of the possibility of it resulting in unnecessary pain for the patient and by extension the family.
I also agree that the patient is an individual no matter what and should be treated like one, especially when it comes to end of life decisions. The only exception would be when the patient is unable to respond for themselves. If this becomes the case, then we should fall back on the patient's will to see what they want. If they don't have a will or anything in writing saying what they want then usually it is up to the family to do what they think the patient would want and this is where it becomes tricky because different family members want different things. Like Amanda said, some family members want more time with that person and so they do what they want so they can spend time with the patient, but you have to think is this really what the patient wants. I wouldn't consider this "quality time" with the patient anyways. If the patient is ready to die and is ready to let go, then you should honor their wishes and do what they want because it is their life. We had a similar situation when my Grandpa passed away about five years ago. My Grandpa had kidney problems and he was put on hospice eventually. From there his liver and kidneys shut down and they said it was only a matter of time. His adopted daughter wanted to keep him alive on machines, but that isn't what my Grandpa wanted and my dad along with my Grandma knew that. When the time came to take him off of life support (because he had passed on his own) my aunt threw a fit, but we all knew that we honored his wishes and he died the way he wanted to and that was all that mattered. It isn't easy letting go (it never is), but it makes it a little easier to accept when you know that you did what that person wanted done. It is definitely important for the patient to make their own end of life decisions as long as they are able. It gives them power over their own life.
The patient is the individual. It is their life they should have the choice to decide what they want to do with their life until they are unable to make rational decisions due to their health whether it is psychological or physical. When it comes down to that phase then it should be up to the person's power of attorney who must follow the will and wishes of the patient. The most important thing is for the patient's wishes to be carried out because they deserve that since it is their life. My family is actually going through this now. My dad is the power of attorney and my grandpa has Alzheimer's and cancer and he has chosen not to go through with the cancer treatments because he has lived a good life and if it is his time he accepts it and doesn't want to go through the pain of chemo. My uncles tried to change my grandpa's decision but when my grandpa was in the right state of mind before the cancer and Alzheimer's hit he had already written down what he wanted if that ever came. So my father follows through on what my grandpa wanted. It causes a lot of turmoil in the family still. This is another reason I think that advance directives are so important.
Just by skimming some of the comments before me, it seems that the majority agree that the patient refers to the individual; I also agree with this statement. The main reason is because it is that particular patient's life, no one elses. Their decision making may affect their family and friends indirectly, but as far as the health and well-being of the "patient" it truly does come down to how it directly affects that individual person. There are some instances when it may involve the family, such as end-of-life situations but should only be the case if that individual knowingly gives up decision-making abilities to those appointed. As long as the patient is aware of everything going on, it should be up to that individual in all instances.
I believe that as long as a patient is capable of making decisions for themselves, they should be the ones with the decision making powers. I certainly believe that a back-up plan should be taken into consideration such as an advance directive to eliminate the vast majority of 'to-be' problems/issues , which also makes everything much more easier on the family of the patient. I completely agree with Amanda that the patient is an individual and should furthermore be treated as an individual up to the end of their life.
Going along with what everyone else has said, a patient is an individual. Obviously family is often involved with medical care and medical decisions, but the bottom line is that the person receiving treatment (as long they are mentally capable) are responsible for making decisions regarding their treatment. This is why there are things such as advance directives, so that if for some reason there is any confusion, the patient has already made his or her decision on what will happen to them.
I believe that is the individual, but there are cases where the family needs to express the patient's wishes. If the patient is not in the right state of mind (even though they are saying they want something or don't want something) I believe that sometimes it would be alright for the family to overrule the patient. However, there must be good reason for it. If the patient is unconscious or in a vegetative state, hopefully they have filled out an advance directive or the family is all aware of the patient's wishes. If not though, then the care needs to be in the best interest of the patient. These debates can break a family apart. This is why the advance directive is so important. The patient should have whatever his or her wishes are fulfilled.
I agree that the patient is an individual with complete autonomy except in cases where he/she cannot speak for her/himself and medical decisions must be deferred to family. That's the short end of it. Do I think this is a good thing? Mostly yes, because it can ensure the patient's desired level of quality in their life. But I think it can be bad too, in cases of futile treatments that do more harm then good to the patient.
I do think that though the family as a whole should not make healthcare decisions for the patient, they should definitely have input. Though the patient is an individual, that individual is usually part of a family unit and should consider the needs and desires of the family. Whether they accept those considerations or not is entirely up to the individual though. This of course can cause arguments between patient and family--but those occur all the time. When the time comes and the patient makes his/her decision, it is the job of the family to be supportive.
I think the patient as an individual should have the right to end of life decisions. Although, if the patient is not a right state of mind (mentally rational) or unable to make the decisions then the family should have the right to make decisions based off of what they think the patient would want. This is difficult though because who then has the final say within the family and we would be assuming that the family member is acting in the best intentions of the patient and not selfishly. I think there would have to be regulations as to who has the executive right to make the decisions, kind of like a chain of command.
A patient is an individual who can make choices for him or her self. Except in cases of mentally ill or minors. Currently I work at Cinicinnati Childrens hospital where your patient is an individual but your point of care is aimed at both the child and the parent. In this situation we treat the patient and family as a whole in reguards to treatment and understandment. Recently I had a chance to hear a doctor talking to a patients mother while taking the childs vital signs and a word that stuck out to me was palliative care. The doctor told the mother that it was like hospice but not. He went on to explain that the diagnosis her child received was life threatening in a way that she will not get better. Palliative care within pediatrics is closely related to the way in elderly, they are given all the care necessary but some surgeries and procedures to extend life would not if seen more harmful than helpful. In this situation the mother had to chose what to do.... On the other hand with who makes the decision about death I believe that it's the patients right to chose to decline or accept treatments. If they are in the right state of mind they should have full say so in what happens to them. Like in most of these topics I believe that different circumstances allow for different options/opinions
I firmly believe that it is 100% up to the patient it is their body and they have to decide what they want to do. However i think family friends etc can be involved if thats what the patient wants. Thats why it important to talk about it before hand. I would hope if a patient is on life support and is not able to tell a doctor what he/she wants, Talking about it before could easily clear things up and not be left up for debate. Thats why its very important to talk about it now matter how awkward because it can save people a lot of heartache and pain.
I think who the patient is varies from case to case. For one person, who is in the hospital and has no immediate family that comes in to visit them or is not on good terms with their family, they are the patient - only the individual. In a case in which the entire family is involved in the experience of the individual being in the hospital, I think the entire group is. Even thought he rest of the family may not actually be affected medically, they have needs in response to the experience. Decision making should go to the individual every time except in circumstances in which they do not have the mental capacity or congnitive capacity to decide. In this case the decision making should go to the person the individual designated for the position.
I do believe that the patient is indeed the person with the illness. That patient has the right over themselves no matter what until death. I like what Michael said above about having a back up plan in case they are unable to respond or communicate at all. The people who determine that are the ones the patient chooses. It would most likely be his or her family or friends.
The patient is an individual. And has every right to be treated as an individual until the very end of life. Unless unable to answer for themselves, due to coma or a serious change in mental status, a patient has every right to make their own decisions about the end of their life. The family makes the situation tricky in some cases because they want to be able to spend more time with that person, but in the end if that person is ready to die, they have every right to refuse treatment. We recently had a situation like this in our family where my Great-Uncle was diagnosed with a very bad infection... he was almost 80 and the only treatment was to amputate his entire leg. He did not want to life the rest of his life in a wheel chair and in major pain after surgery, so he decided to not forgo the surgery. His children were very upset with him that he did not want to continue and fight, but it was his choice. Patient autonomy is very important for a nurse, and any other medical professional to be conciderate of. It is the patients own choice to decide what they want to do with their life.
ReplyDeleteThe patient is an individual whether they are conscious or not, separate from the family. As far as who should have decision making powers at end of life depends on the level of consciousness of the patient. If the patient is able, they should be the one making the decisions, and if not that power should obviously fall to the family. However, even in the optimal scenario where the patient is fully aware the patient and the family should discuss what they think is the best course of action as far as treatment because what affects the patient also affects the family. For instance, if a certain treatment will put the patient through a lot of pain with varied results it is important for the patient to discuss whether or not to go ahead with the procedure with their family because of the possibility of it resulting in unnecessary pain for the patient and by extension the family.
ReplyDeleteI also agree that the patient is an individual no matter what and should be treated like one, especially when it comes to end of life decisions. The only exception would be when the patient is unable to respond for themselves. If this becomes the case, then we should fall back on the patient's will to see what they want. If they don't have a will or anything in writing saying what they want then usually it is up to the family to do what they think the patient would want and this is where it becomes tricky because different family members want different things. Like Amanda said, some family members want more time with that person and so they do what they want so they can spend time with the patient, but you have to think is this really what the patient wants. I wouldn't consider this "quality time" with the patient anyways. If the patient is ready to die and is ready to let go, then you should honor their wishes and do what they want because it is their life.
ReplyDeleteWe had a similar situation when my Grandpa passed away about five years ago. My Grandpa had kidney problems and he was put on hospice eventually. From there his liver and kidneys shut down and they said it was only a matter of time. His adopted daughter wanted to keep him alive on machines, but that isn't what my Grandpa wanted and my dad along with my Grandma knew that. When the time came to take him off of life support (because he had passed on his own) my aunt threw a fit, but we all knew that we honored his wishes and he died the way he wanted to and that was all that mattered. It isn't easy letting go (it never is), but it makes it a little easier to accept when you know that you did what that person wanted done. It is definitely important for the patient to make their own end of life decisions as long as they are able. It gives them power over their own life.
The patient is the individual. It is their life they should have the choice to decide what they want to do with their life until they are unable to make rational decisions due to their health whether it is psychological or physical. When it comes down to that phase then it should be up to the person's power of attorney who must follow the will and wishes of the patient. The most important thing is for the patient's wishes to be carried out because they deserve that since it is their life. My family is actually going through this now. My dad is the power of attorney and my grandpa has Alzheimer's and cancer and he has chosen not to go through with the cancer treatments because he has lived a good life and if it is his time he accepts it and doesn't want to go through the pain of chemo. My uncles tried to change my grandpa's decision but when my grandpa was in the right state of mind before the cancer and Alzheimer's hit he had already written down what he wanted if that ever came. So my father follows through on what my grandpa wanted. It causes a lot of turmoil in the family still. This is another reason I think that advance directives are so important.
ReplyDeleteJust by skimming some of the comments before me, it seems that the majority agree that the patient refers to the individual; I also agree with this statement. The main reason is because it is that particular patient's life, no one elses. Their decision making may affect their family and friends indirectly, but as far as the health and well-being of the "patient" it truly does come down to how it directly affects that individual person. There are some instances when it may involve the family, such as end-of-life situations but should only be the case if that individual knowingly gives up decision-making abilities to those appointed. As long as the patient is aware of everything going on, it should be up to that individual in all instances.
ReplyDeleteI believe that as long as a patient is capable of making decisions for themselves, they should be the ones with the decision making powers. I certainly believe that a back-up plan should be taken into consideration such as an advance directive to eliminate the vast majority of 'to-be' problems/issues , which also makes everything much more easier on the family of the patient. I completely agree with Amanda that the patient is an individual and should furthermore be treated as an individual up to the end of their life.
ReplyDeleteGoing along with what everyone else has said, a patient is an individual. Obviously family is often involved with medical care and medical decisions, but the bottom line is that the person receiving treatment (as long they are mentally capable) are responsible for making decisions regarding their treatment. This is why there are things such as advance directives, so that if for some reason there is any confusion, the patient has already made his or her decision on what will happen to them.
ReplyDeleteI believe that is the individual, but there are cases where the family needs to express the patient's wishes. If the patient is not in the right state of mind (even though they are saying they want something or don't want something) I believe that sometimes it would be alright for the family to overrule the patient. However, there must be good reason for it. If the patient is unconscious or in a vegetative state, hopefully they have filled out an advance directive or the family is all aware of the patient's wishes. If not though, then the care needs to be in the best interest of the patient. These debates can break a family apart. This is why the advance directive is so important. The patient should have whatever his or her wishes are fulfilled.
ReplyDeleteI agree that the patient is an individual with complete autonomy except in cases where he/she cannot speak for her/himself and medical decisions must be deferred to family. That's the short end of it. Do I think this is a good thing? Mostly yes, because it can ensure the patient's desired level of quality in their life. But I think it can be bad too, in cases of futile treatments that do more harm then good to the patient.
ReplyDeleteI do think that though the family as a whole should not make healthcare decisions for the patient, they should definitely have input. Though the patient is an individual, that individual is usually part of a family unit and should consider the needs and desires of the family. Whether they accept those considerations or not is entirely up to the individual though. This of course can cause arguments between patient and family--but those occur all the time. When the time comes and the patient makes his/her decision, it is the job of the family to be supportive.
from SHAD
ReplyDeleteI think the patient as an individual should have the right to end of life decisions. Although, if the patient is not a right state of mind (mentally rational) or unable to make the decisions then the family should have the right to make decisions based off of what they think the patient would want. This is difficult though because who then has the final say within the family and we would be assuming that the family member is acting in the best intentions of the patient and not selfishly. I think there would have to be regulations as to who has the executive right to make the decisions, kind of like a chain of command.
A patient is an individual who can make choices for him or her self. Except in cases of mentally ill or minors. Currently I work at Cinicinnati Childrens hospital where your patient is an individual but your point of care is aimed at both the child and the parent. In this situation we treat the patient and family as a whole in reguards to treatment and understandment. Recently I had a chance to hear a doctor talking to a patients mother while taking the childs vital signs and a word that stuck out to me was palliative care. The doctor told the mother that it was like hospice but not. He went on to explain that the diagnosis her child received was life threatening in a way that she will not get better. Palliative care within pediatrics is closely related to the way in elderly, they are given all the care necessary but some surgeries and procedures to extend life would not if seen more harmful than helpful. In this situation the mother had to chose what to do.... On the other hand with who makes the decision about death I believe that it's the patients right to chose to decline or accept treatments. If they are in the right state of mind they should have full say so in what happens to them. Like in most of these topics I believe that different circumstances allow for different options/opinions
ReplyDeleteI firmly believe that it is 100% up to the patient it is their body and they have to decide what they want to do. However i think family friends etc can be involved if thats what the patient wants. Thats why it important to talk about it before hand. I would hope if a patient is on life support and is not able to tell a doctor what he/she wants, Talking about it before could easily clear things up and not be left up for debate. Thats why its very important to talk about it now matter how awkward because it can save people a lot of heartache and pain.
ReplyDeleteI think who the patient is varies from case to case. For one person, who is in the hospital and has no immediate family that comes in to visit them or is not on good terms with their family, they are the patient - only the individual. In a case in which the entire family is involved in the experience of the individual being in the hospital, I think the entire group is. Even thought he rest of the family may not actually be affected medically, they have needs in response to the experience.
ReplyDeleteDecision making should go to the individual every time except in circumstances in which they do not have the mental capacity or congnitive capacity to decide. In this case the decision making should go to the person the individual designated for the position.
I do believe that the patient is indeed the person with the illness. That patient has the right over themselves no matter what until death. I like what Michael said above about having a back up plan in case they are unable to respond or communicate at all. The people who determine that are the ones the patient chooses. It would most likely be his or her family or friends.
ReplyDelete