Terminally Ill Patients
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Elizabeth Kubler-Ross is credited with introducing the subject of death and dying as a legitimate subject for discussion in medical circles, and the community as a whole, and her book On Death and Dying is required reading in most major nursing and medical schools (Redwood). Kubler-Ross, her self a physician, began her pioneering work with the terminally ill at the University of Colorado Medical Center in Denver, and her interest in death and dying was sparked by a visit to a concentration camp where thousands of children had died in the gas chambers, leaving behind walls covered with drawings of butterflies. Kubler-Ross was fascinated with how normal human beings could become killers of children, and this inspired her to become a doctor and study death and dying. Kubler-Ross, in an interview in 1995, believed that those caring for the dying should be honest with them, answering all their questions honestly, but not volunteering any information that was not asked for (Redwood). She believed if they did not ask about something, it was because they were not ready to hear the answer. She also believed strongly that you should never take away hope from a dying person because without hope, they would not live, and you never know what is just around the corner. One thing you should do, she said, is to avoid cliches like, ôItÆs GodÆs willö or ôThings will work out for the bestö or ôEverything happens for a reasonö (Kubler-Ross). The American Medical Association (AMA) defi
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in refusing unwanted medical care.ö A patientÆs assessment of the benefits weighed against the burden of the treatments should prevail.
The order of priority in decision-making is advanced directives, substituted judgements, and the best interest of the patient, according to the Ethics Manual of the American College of Physicians (Death). The patientsÆ informed goals and choices should be made through an advanced directive, but oral statements to family members, friends, and healthcare professionals also come under the heading of advanced directives. However, because oral directives could have been vague comments and could be ambiguous, written directives are preferable. Living wills have only a narrow scope of application, and in most states only apply to terminal patients and not those in permanent vegetative states. Some states exclude intravenous fluids and tube feeding from the interventions which may be refused, and then it is left up to the courts to decide. The durable power of attorney is more flexible, and the patient can be more explicit to their surrogate about just which treatments they do and do not want to undergo. Regulations on the durable power of attorney vary from state to state.
The Patient Self-
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Approximate Word count = 3100
Approximate Pages = 12 (250 words per page)
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