Ethical issue in end of life

Discussing an ethical issue in the context of end of life.
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The most painful event in life is when one loses someone close to them. The people they shared
memories with both good and bad. The extent of the hurt often does depend on the situation that
they find their loving members. There is a huge difference between a person who dies suddenly
and one whom the family members watch while he slowly fades. The situation also does worsen
when the family handles the responsibility of caring for their loved ones as they approach the end
of their life gets to see the strong personality of their loved one that they cherish fade away
replaced by pain (Gillan et al., 2014, p.332).
The essay is based on the image of the dying father and child it was created between 1909 to

  1. The image was part of George Eastman House collection and was created by Lewis W.
    Hine an American who lived between 1874 to 1940. Based on the title, the father is dying, and
    he is surrounded by five children and the wife. Due to the lighting in the room, the image was
    created during the day and most probably during the holiday or weekend as the entire family is
    present in the room.
    The children are present, and they get to witness the death of their parent. It is a sad event and
    something that may end up leaving them traumatized or scarred for life. In the picture, one can
    see one of the children covering their eyes it is inferred to mean that they do not want to see their

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father pass away or they are crying. Tears are a means of expressing our sadness especially in a
dreadful situation like death (Murphy 2016 et al., p.254).
It is globally accepted that we will all die at one point in our lives, but no one is ready to see
death approach especially when they are not ready (Rowland et al., 2016). As illustrated in the
picture, the father is receiving home care as he nears his death. The aspect of patients being taken
care of at home arises from two aspects either the hospital has done all they can and informed the
patients who decide to spend their last days at home. The second reason deals with the lack of
finances, where the family cannot afford to have their patient admitted in the hospital (Tong et
al., 2014, p.915).
The family is better placed to understand what their suffering member requires as they near their
death from an emotional and spiritual perspective. The emotional perspective is more important
to the passing member as they need to feel that someone cares about them. The care they receive
solidifies the concept that their lives were worthy in the long run. This is the reason that most
members gravitate to their families as they approach their end days (Davies et al., 2014, p.919).
The care is given to the patient often takes different forms depending on their state of mind and
disease. In the case of members suffering from chronic diseases like cancer, the pain is often
reflected in their eyes and weary bodies. The family members need to assist their loved ones with
the help of the medical practitioner to aid the person spend their last days being as comfortable
as possible. The aspect of treatment and euthanasia does come into play when discussing the end
life care (Wilson, 2013, p. 504).
At times the treatment of people with chronic diseases becomes very expensive to the point that
they decide to stop the treatment to save their families the burden of incurring a massive debt

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(Mathers et al., 2013, p.206). Does the family have a role to play in altering the decision made by
the suffering member?
According to Quaghebeur et al., 2011, p.475, the patient has the autonomy to make decisions
about their own lives. This is referred to as the principle of autonomy where one has the right to
make a rational decision on how to end their lives in the case of serious illness. The family
members have a minimal role in altering the decision of the patient in the case they are still
capable of making a sound decision. Despite, this they can discuss with the family member and
convince them of continuing with the treatment if they have the finances (Visser, Deliens, and
Houttekier, 2014, p.604).
The principle of beneficence states that people should act with the aim of fostering the well-
being of others. This principle often governs the interaction of physicians and their patients
where they carry out the role of ensuring the welfare of their patients. On the other hand, the
nonmaleficence principle states that people should behave in ways that ensure that they do not
cause any grievance to other people. The principles are applied to the end of life care where the
nurses who interact with the patients play the role of helping the families accept that their loved
one is nearing their end of life (Quaghebeur et al., 2011, p. 476).
Based on Ewing et al., 2014, p.248, the nursing team has the responsibility from the moral and
legal perspective of discussing with the patients the decisions they are to undertake. Once the
patient has made their decision, their role comes to an end. Some of the responsibilities that they
undertake based on this context are; offering the family members and the patient advice on the
treatment available, the cost and what they consider the best option.

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The second scenario inferred from the picture focuses on elevating the suffering of both the
dying father and the children is euthanasia also referred to as assisted dying. According to the
principle of justice and human dignity, every person is required to give according to what they
have and receive concerning their possibilities ((Quaghebeur et al., 2011, p. 477).
In the pretext of euthanasia, the justice principle is applied as a form of providing good care to
the suffering patient. Euthanasia refers to the intentionally ending the life of a person with the
aim of relieving them from the pain that they are undergoing. This is often encouraged in
situations where the person is suffering from a chronic and painful disease or is in a coma that is
irreversible.
From the legal perspective, the states of New South Wales and Victoria are moving towards
drafting legislation that permits euthanasia for Australian citizens (Teno et al., 2013, p.470). The
condition stimulated to allow euthanasia is when the patient is suffering an incurable disease that
will necessitate them to terminate their life. The decision to give the go ahead for euthanasia lies
with the family members and the patients as long as they are above the age of 25 years. Also, the
family member at the end of their life needs to have a sound mind at the point of deciding
(Morton et al., 2017).
In the case of the dying father and child picture, the love and pain are evident in the way they
have gathered around the father. The children love their father and are very young to witness the
end of his life. Traumatic events like death often inhibit the effective development of people
especially children (Berg, 2014).
Based on the picture the children are very young most of them are below the age of 15 a clear
sign that their brain is still developing. I am certain that it is not right, but in this case, it is not

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fair for them to witness such immense suffering of someone they love dearly. Euthanasia would
have been a better way to end the pain that they are all experiencing. In this case, the father
should have decided to decide to save the elder family member from experiencing any guilt from
the incident (Anaf, 2017).

Conclusion

The end of life care is important to the person seeing their life fade away. Most prefer to spend
their last days with their families to stay in the hospital. The picture that guides the reflective
essay displays this concept. The love and care given by the members enable them to feel
comforted as they prepare themselves psychologically for their departure. The end of life care
takes different forms as discussed in the essay it can be through euthanasia, hospitalization or
home care. The common denominator in all the three forms is the practitioners’ medical advice.

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REFERENCES

Anaf, J. M. (2017). Voluntary euthanasia laws in Australia: are we really better off dead? The Medical
Journal of Australia, 206(8), 369.
Berg, L., Rostila, M., Saarela, J., & Hjern, A. (2014). Parental death during childhood and subsequent
school performance. Pediatrics, peds-2013.
Davies, N., Maio, L., Rait, G., & Life, S. (2014). Quality end-of-life cares for dementia: What have
family carers told us so far? A narrative synthesis. Palliative medicine, 28(7), 919-930.
Ewing, G., Grande, G., & National Association for Hospice at Home. (2013). Development of a Carer
Support Needs Assessment Tool (CSNAT) for end-of-life care practice at home: a qualitative
study. Palliative Medicine, 27(3), 244-256.
Gillan, P. C., van der Riet, P. J., & Jeong, S. (2014). End of life care education, past and present: A
review of the literature. Nurse Education Today, 34(3), 331-342.
Mathers, S. (2013). End of Life Care in Progressive Neurological Disease: Australia. In End of Life Care
in Neurological Disease (pp. 205-212). Springer London.
Morton, P. G., Fontaine, D., Hudak, C. M., & Gallo, B. M. (2017). Critical care nursing: a holistic
approach. Lippincott Williams & Wilkins.
Murphy, B. J. (2016). Voluntary euthanasia laws in Australia: are we really better off dead? The Medical
Journal of Australia, 205(6), 254-255.
Quinlan, M. (2016). “Such is Life”: Euthanasia and capital punishment in Australia: consistency or
contradiction? Solidarity: The Journal of Catholic Social Thought and Secular Ethics, 6(1), 6.
Quaghebeur, T., Dierckx de Casterle, B., & Gastmans, C. (2009). Nursing and euthanasia: a review f
argument-based ethics literature. Nursing ethics, 16(4), 466-486.
Rowland, C., Hanratty, B., van den Berg, B., Pilling, M., & Grande, G. (2016). Valuing friends’ and
family support for end of life cancer care: A national study of the economic costs of informal
care giving. Palliative Medicine, 30(6), NP34.

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Teno, J. M., Gozalo, P. L., Bynum, J. P., Leland, N. E., Miller, S. C., Morden, N. E., … & Mor, V.
(2013). Change in end-of-life care for Medicare beneficiaries: site of death, place of care, and
health care transitions in 2000, 2005, and 2009. Jama, 309(5), 470-477.
Tong, A., Cheung, K. L., Nair, S. S., Tamura, M. K., Craig, J. C., & Winkelmayer, W. C. (2014).
Thematic synthesis of qualitative studies on patient and caregiver perspectives on end-of-life
care in CKD. American Journal of Kidney Diseases, 63(6), 913-927.
Visser, M., Deliens, L., & Houttekier, D. (2014). Physician-related barriers to communication and
patient-and family-centred decision-making towards the end of life in intensive care: a
systematic review. Critical Care, 18(6), 604.
Wilson, D. M., Cohen, J., Deliens, L., Hewitt, J. A., & Houttekier, D. (2013). The preferred place of last
days: results of a representative population-based public survey. Journal of Palliative Medicine,
16(5), 502-508.

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