psych218 - Medical Level Withdrawal of Life Support - Mrs....

Info iconThis preview shows pages 1–2. Sign up to view the full content.

View Full Document Right Arrow Icon
Medical Level Withdrawal of Life Support - Mrs. J 77 years old on life support in ICU for chronic obstructive pulmonary disease - she has two sons and a daughter where Mr. G, one of her son, is the power of attorney - patients rarely participate in discussions because they feel too sick or are heavily sedated - thus decision falls on family or surrogate decision maker - decisions are emotionally stressful and can cause disagreement - failure to resolve disagreements can compromise patient care - need effective communications - decisions to withdraw life support are appropriate in many clinical situations - every adult patient with decision-making capacity has the right to determine what treatments he or she will receive autonomy (can also be done by power of attorney() - doctors didn’t discuss other options to Mr. G - Mrs. J didn’t want to make any decisions so she assigned Mr. G as power to attorney but he was never comfortable with it - advance care planning is an opportunity for patients to direct their care even when illness prevents them from speaking for themselves but studies show that advance directives do not cause patients’ wishes to be followed more closely - Mrs. J didn’t want to be intubated, but the doctors did it anyways so when Mr. G came to see her, he wanted to take the tube out (even the doctors were happy to take the tubes out but didn’t want Mr. G to tell them to put it back in) - physicians were to share the decision-making responsibility but they didn’t, they put all the responsibility on Mr. G alone, so it was a burden for him - doctors didn’t try to understand patients’ wishes - process of letting go family member: cognitive aspects (seek information and understanding about illness, what medical care is good); affective aspects (bring closure to a life by framing prospect of death to avoid cultural taboo of giving up); interpersonal aspects (protect and maintain family relationships threatened by decision to withdraw lie support) - doctors that decision of withdrawing life support was very easy and thought Mr. G had an easy time and was happy to make that decision when in fact he is still uncomfortable that he made the right decision or not - disagreements on withdrawing life support from family members - physicians are accustomed to withdrawal of life support so fail to attend to human drama - most frequent withdrawn therapies are (in order): blood products, hemodialysis, vasopressors, mechanical ventilation, total parenteral nutrition, antibiotics, intravenous fluids, enteral feedings - family participation in patient care may provide sense of comfort, intimacy, involvement - family members prefer to be present at the time of death - health professionals have not been prepared adequately to deal with emotions associated with death and dying - primary goal of critical care is to save lives of patients who would die without its aggressive interventions but now focusing on patients who live but cannot recover Caregiving at the End of Life
Background image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Image of page 2
This is the end of the preview. Sign up to access the rest of the document.

This note was uploaded on 11/08/2010 for the course PSYCH 218 taught by Professor Burris during the Fall '10 term at Waterloo.

Page1 / 19

psych218 - Medical Level Withdrawal of Life Support - Mrs....

This preview shows document pages 1 - 2. Sign up to view the full document.

View Full Document Right Arrow Icon
Ask a homework question - tutors are online