Withdrawal Of Life Support

Withdrawal Of Life Support
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INTRODUCTION
Hearing it from the news, you probably understand the decisions to withdraw life. A notable case in 2005 in the media of Terry Schiavo that dealt with whether to decide to discontinue the life of her husband which sparked a national debate. It's not the first case we've heard in America, life support or nutritional support in treatment is meant to prolong life without changing the situation of that person's condition. This includes artificial nutrition, kidney dialysis, chemotherapy, mechanical ventilation and antibiotics. Advanced technology in medicine is helping people to live longer; including the lives of people who cannot sustain life on their own at their own expense. These artificial means, allows someone the chance to live longer or to recover if possible.
METHODOLOGY
This paper is based on discussion, analysis and review of data that mainly develop through relevant secondary sources. These include: Publications in English language, known reviewers and texts, Bibliographies from included texts, live saving populations and research-based studies. A number of databases used in the process are Pub Med or Medline, national Institute of Health, American Family Physician and the Cochrane Collaborations. These databases included in the main sources have provided necessary information ranging from the ethics to the development of the withdrawal of life support and some case studies carried out in American medical Institutes.
LIMITATIONS OF THE STUDY
Two major limitations encountered in this study were on limitation of sources and on the available data in some aspects. For instance, for such a controversial topic, the case studies available are not discussed by many institutes or in depth as expected. Analyzing some key determining aspects in this topic like the cost for instance was problematic due to the widely varying range of costs across the states and depending on the health institute.
PURPOSE OF THE STUDY
The AMACME (American Medical Association’s Code of Medical Ethics) states, "A competent person, may formulate or provide consent to the withdrawing and withholding of life-support systems if that injury renders them incompetent to make that decision. This decision can be made in the form of a Living Will or Advanced Health care Directive allows someone to make that decision for them if they are not able to make it. The important thing to do is, knowing what that patient would want if they were conscious and your own evaluation decisions about the expectations of the patient to recover, the benefits, risks and review the Preferred Intensity of Care form if you're in a nursing home. If you don't know much about the patient, you should consult that persons relative or friends, to ask them what that person would want. It will help you to decide whether to keep that person alive or not (Way, Back, & Randall, 2002).
Clinical intensive care unit machines often care for patients who are on life support when a patient is dying, according to an American Journal-Respiratory and Critical care medicine, the sequential withdrawal, is relatively common and has an impact on the family's satisfaction with ICU. Withdrawal of life support can be very traumatic once a patient enters the Intensive Care unit they die after a prolonged stay in the ICU which the doctors feel is not in their patients' interests. Studies suggest, how ICUs are conducted is not consistent with what people take as the best approach. According to Dr. J. Randall Curtis (2010), "This is a wake-up call to physicians working in the ICU to look critically at the ways they think about this and do this." At the Washington School Medicine University, from the department of pulmonary division and critical care.
There is little emphasis on palliative care in Intensive Care Units referred to as "impersonal" with no specific guidelines of how doing this, most terminally ill patients would not support the idea to have their care withdrawn. The study published in the American Journal of Respiratory and Critical Care Medicine, involved the examining of medical charts by family members of 584 patients that had died in the ICU at one of the 15 hospital in life support. For almost half the patients, withdrawal took more than one day. The patients were young and had experienced several life support interventions and had more people in deciding their fate, where four life-support ranging from, artificial nutrition and ventilators. The removal of the ventilators was the most satisfying decisions before death by most family members.
Conflicts between Clinicians and family is common, it rises from communication, pain control, interpersonal interactions, as well as decisions in treatment. One study of withdrawal was thought to raise conflicts between families and clinicians in 48% cases. Evidence of how to end the conflicts was through negotiation and communication strategies which are the most important tools of ending the conflict. One problem in decision implementation, is to allow decision makers to use their own judgement, instead of being held by advanced directive specifics, and to allow clinicians to have a listening as well as a skillful ability to negotiate with families in making treatment decisions. A study conducted showed 78% of patients wanted their families or friends wishes to be implemented in case their preferences did not tally with their families (Jenny Way, 2002). Uncovering differences in legitimate and value concerns have been discussed inadequately. Goals, treatment and prognosis options will help to resolve major conflicts and help to minimize unrealistic requests by patients.
Families attending to the dying patient can be distracted by various activities happening in the life support machines as the patient is beginning to die, rather than concentrating on the patient who is about to die. One of the ways to prepare the room for the last ceremony before the death of the patient is to remove the monitors, which eliminates noise that will sound when the patient is dying. Pulse and respiratory rate help to determine when a patient is about to die and is used to indicate when a patient is suffering. Removing a patient from monitors can be an essential step to a comfort solution which symbolizes the breakage from the physiological monitoring which is a part of the intensive care unit. Perform sedation and analgesia before you remove all biliary drains, tubes and lines to prevent suffering and anxiety (Luce, Rubenfeld, 2001).
Sedation may not be offered to patients who are critically ill as a result of respiratory suppression or drug-related-hypotension since it affects life maintenance. Nonetheless, when offering a patient the last comfort, any amount will be justifiable even if it leads to death. Although in cases where a patient is able to communicate his or her wishes can suggest the amount they should receive, and should be completely comfortable before you make them unconscious. When demonstrated signs of discomfort have been eliminated, doses can be increased to provide adequate sedation. Large doses of narcotics can be necessary to relieve pain from patients with high ventilatory drives and surgical wounds.
Given the unpredictability an individual response towards drug tolerance, it is difficult to plan a single pharmacological routine to apply in every situation. Pain management and anxiety in critical care, recommends a mixture of morphine or other alternatives of narcotics with a benzodiazepine. When these medications are dosed properly, they provide an adequate sedation and analgesia in almost all situations. A failure in benzodiazepine /opiate combination may prove the use of propofol, haloperidol, or barbiturates.
Essentially, nurses should be trained to document the objective rationale for the increasing doses of palliative medicine. For example, plotting Morphine drip enhanced up-to 15 mg/hour after 15 mg IV bolus was administ...