Terminal illness is a disease, which is ultimately incurable. A condition is termed terminal, if after diagnosis and treatment, the patient is likely to die. However, it is possible for patient diagnosed with terminal diseases to live for long before succumbing to medical condition. According to Parkes, Relf and Couldrick (1996), “Only when any reasonable hope of cure is gone will drastic treatment be discontinued” (p. 74). Doctor do all they can save life of the patient. As Parkes, Relf and Coulrick (1996) continue to explain some doctors will never give up, and the consequences of this patient can be awful (p. 74).
There are several diseases, which leads to fatal conditions. Smith in his article “what is a terminal illness” argues that, diagnosis of a terminal illness can be a traumatic event for all patient and his or her relatives, and is normally accompanied by offers of psychological counseling and similar assistance. It is important for the patient to understand that every diseases is fatal and when one is diagnosed with any infection there are only two possibilities; to live or to die, no matter what one is suffering from. Examples of terminal illness are; cancer, end stages of Acquired Immunodeficiency Syndrome (AIDS), among others.
Medical practitioners work hard to find out and treat diseases and infections while still at early stages. Nevertheless, sometimes a condition goes for some time undetected, a patient is unable to get proper care, or the disease is virulent enough to resist medical intervention. These are some of the reasons, which lead to conclusion of a fatal condition, following a thorough diagnosis. Smith continues to say that once a doctor recognizes that he or she can no longer reasonably expect to cure the diseases or infection, attention turns to counseling the patient.
It is normal to receive less treatment from the doctor once you have been diagnosed with a terminal illness. Smith argues that, often, the treatment for a serious disease can be as painful and uncomfortable as the disease itself. Also it doesn’t make any sense to continue with treatment if it is no longer effective. However, the decision to end treatment is an agreement between the patient and his or her doctor and in most cases terminal patient have an active role in their medical treatment. They often write directives showing how they would like to be cared for while at the terminal stage and request their family members to ensure that their wishes are adhered.
Once the patient agrees with his or her doctor to end the treatment, and then is placed on palliative care. This is normally to done to relief him or her from pain as well as designing other measures to make the terminal stage as comfortable as possible. It is important to clarify that these palliative care facilities do not aim at saving life or engage in any measure related to saving patients life such as resuscitating patients or emotionally and physically draining treatments like chemotherapy as Smith explains. The professionals of palliative care facilities struggle to ensure that their patients have dignified, comfortable death without fear and pain.
Generally, to any person to be informed that your medical condition is fatal can be a very intense experience. However, it is important and also a responsibility of a doctor after diagnosis conclusion to inform both the patient at the family members the condition. As Smith puts it, terminal illness gives everyone concerned a period of time to come to terms with terms, which can be very valuable. Smith concludes by saying that, terminal patients need the support and love of their relatives and friends. This is most important, compassionate, which can be shown to the patient.
According to the State of Maine Board of Osteopathetic Licensure, the term “advanced directives” means any spoken or written instructions you give about the health care you want if a time comes when you are too ill to decide. It is preferable to put it down in writing since some instructions are needed to be in writing, However, it is not mandatory to write, especially when the patient cannot write, he or she can give the speech which in turn can be recorded for reference. “A health care power of attorney is an example of an advanced directive that must be in writing” as the State of Maine Board of Osteopathetic depicts.
According to the Maine state laws, if one has signed an advanced directive, it is important to keep it in a safe place and ensure that your doctor, hospital, and your relative have a copy. If one has not yet signed the form, he or she may choose to use the Maine Health Care advanced directive form. In case the patient is too ill to make independent decision about his or her care, the form allows others to know which treatments one needs and which he or she don’t. This is important because family members will not guess.
The government of Maine stipulates seven parts of the Maine Health Care Advanced Directive Form which allows many options. As explained, by the State of Maine Board of Osteopathetic Licensure, anyone who is eighteen years and above may use the Maine Health Care Advanced Directive Form in whole or in part. In case one is younger than eighteen years, he or she may be able to use an advanced directive but under certain limited circumstances. Each part is about unique option. One is supposed to sign his or her advanced directive in part 6. Below is a detailed explanation of each part as stated in Maine government website http://www.maine.gov/dhhs/oes/resource/rit2chew.htm;
Part 1 Choose an agent – This part is called a health Care of Attorney where you name a person to make health care decisions for you. The person you choose to make your health care decisions is your health care decision agent. Your agent can be an adult family member or friend. A person who owns or works at the nursing home or other residential facility where you live cannot be your agent, unless the person is also a member of your family. If you choose an agent, two adult witnesses must sign your advance directive. Your agent may not be a witness.
Part 2 Choose treatment you want and don’t want – In this part you can choose what you wish to have done if you are dying, in a coma or too ill to speak for yourself. Your agent must follow any choices you make in an advance directive.
Part 3 Name your primary care physician (or nurse practitioner or physician assistant)
Part 4 State your wishes about donating your body, organs or tissues at death
Part 5 State your wishes about funeral and burial arrangements
Part 6 Sign and date your advance directive
Part 7 Sign a Do Not Resuscitate (DNR) form, if your breathing or your heart stops and you do not want an ambulance crew to try to revive you, this form must be signed by you and by your physician (or nurse practitioner or physician assistant).
According to Brown and Myers (2008) majority of states have passed statutes called surrogate decision-making laws, which permit a close relative or friend to make health-care decisions for patients who have no advance directives (p. 398). These laws aim at helping patients who are diagnosed with terminal diseases and gets into a condition where they can’t their own decisions. Brown and Myers (2008) continue to explain that, these laws make unnecessary the need to seek court permission by allowing family members to make decisions about life-sustaining treatment (p. 398).
Advance directives have several major purposes. Martzo and Sherman (2006) say the first and perhaps most important is that they are mechanism by which individuals who are currently competent indicate the type of healthcare they would like should they lack decision-making capacity at some time in future when a medical decision needs to be made (p. 148).
There are clear guidelines to healthcare providers and relatives concerning the kind of medical care one would desire to receive in advance of the need for that care. Martzo and Sherman (2006) say “Advance directives generally are discussed in the context of the right to forgo life-sustaining treatments” (p. 148). Nevertheless, advanced directives can be used to guide administration of specific treatments as they were in the case of Harriet billings. Martzo and Sherman (2006) argue that advance directives pertain to decision making about any kind of healthcare, and they may be executed by any adult as long as he or she possesses the requisite decision making capacity (p. 148).
The second purpose of advanced directives as Martzo and Sherman (2006) explains is to provide guidance, especially to healthcare professionals, concerning how to proceed with decision making about life-sustaining treatment for patient with diminished capacity (p. 148). In case the patient is not in a position of making decision, a great deal of confusion can occur, concerning how healthcare decisions are to be made, who has authority to make them, and the kind of treatment to be offered. It has been found that relatives of the patient with advanced directives do report fewer issues with communication with healthcare providers concerning treatment decisions and believed that the directives had contributed the process.
According to poor and Poirrier (2001) knowing what is right at the end life situation is not enough (p. 96). It is important to give clear in information to the relatives on how one needs to be taken care of in the terminal life. As Poor and Pierre (2001) explains even nurses are not able to make such decisions for patient and they act alone (p. 96).
Brown, G. & Myers, S. (2008). Administrative of Wills, Trusts, and Estates (4th ed.). Great New York City Area, NY: Cengage Learning.
Parkes, C. M., Relf, M. & Couldrick, A. (1996). Counselling in terminal care and bereavement. Great New York City Area, NY: Wiley-Blackwell.
Poor, B. & Poirrier, G. P. (2001). End of life nursing care. Sudbury, MA: Jones & Bartlett Learning.
Sherman, D. W. (2006). Palliative care nursing: quality care to the end of life (2nd ed.). Warren, MI: Springer Publishing Company.
Smith, S. E. (2010). What is a terminal illness? Retrieved November 9, 2010 from http://www.wisegeek.com/what-is-a-terminal-illness.htm
The State of Maine Board of Osteopathetic Licensure (2008). Elders Services. Retrieved November 9, 2010 from http://www.maine.gov/dhhs/oes/resource/rit2chew.htm
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