The Role of Nursing at the End of Life
Nicole Lehr | Scrubs Magazine
Although discussing end of life care is often avoided in the general robust working population, working in the healthcare industry has made me highly aware of the importance of making these difficult decisions before it is too late.
Typically, when a patient is admitted to the hospital, options for advanced directives are presented and decisions about said directives are encouraged. As some background, advanced directives are more or less directions that your doctors should follow regarding your care if you should be unable to verbalize wants and desires based on medical condition.
The various types of advanced directives that exist include the living will, durable power of attorney, and do not resuscitate orders. The living will gives specific instruction on what care to or not to provide prior to an event that deems a person incapable of making their own decision due to coma or other terminal illness. A living will differs from a durable power of attorney in that when a durable power of attorney is assigned, that person/those people (typically a family member or close friend) are responsible for making all medical decisions for the incapacitated person. In addition, a person can preemptively opt for a do not resuscitate order as well that gives specific direction to not resuscitate a patient via CPR if the need arises.
Prompted by reports of miscommunication mishaps between healthcare personnel regarding end of life issues on patients with various advanced directives, I have a renewed appreciation for the importance as a healthcare provider of knowing the difference between the options and try to have a clear understanding of what my patient’s desires are.
Now, these somewhat appearing clear-cut options become more complicated when working with a pediatric population. A parent of any patient under the age of 18 has legal custody, legal decision-making ability, and basically the right to choose between life and death for their child. It is unfortunate and devastating for a parent of an infant that is being kept alive by life support means including tubes, wires, and drains to make a decision of whether or not quality of life for their child should overrule quantity.
Every parent makes these decisions differently based on emotions, knowledge-base, values, religious beliefs, etc., and in reality there is no right or wrong answer. As healthcare providers it is our responsibility to appropriately educate the parents on their options, support them if they need a shoulder to lean on, and maintain an unbiased opinion when the final decision is made.