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I remember 10 May as if it was yesterday. It was a grey day. I was extremely tired but excited at the same time. My first block finally came to an end. Most of my patients were discharged at the time except for 2. I decided to see the 20 year old first. The session went quick as it is much easier to work with someone who’s in happy spirits.
The 87 year old, on the other hand was lying rolled up in a small ball – captivated in her misery as she called it. Terminally ill, end stage lung and liver cancer. “You’re the soft one, just be gentle and get her to consent.” This was my clinician’s thought process. According to her I had a better chance on convincing a patient into treatment. I approached my clinician, I really wanted to avoid this situation. Before I could talk she uttered the following: “No, Tameron, that’s final”. It was exactly one month and five days where I lost someone very dear to my heart. She had the exact same diagnosis.
I ended up seeing my patient. An old lady who seemed kind; but in a lot of pain. I avoided the long list of questions, took her hand and nodded. A tear left her right eye. “I want to go home. They treat me like I’m an animal. I want to die in peace. Why can’t they take me home? Why do they put me through all this suffering? I have had a full life. Can they please let me die, in peace?”
My patient begged me to speak to her daughter. I could see that she has come a long way with all this pain and suffering. She wants to rest. I promised to speak to her daughter, but I could not do it. It wasn’t my place to do it. She indicated that she had a conversation with her doctor about end-of-life measures – she seemed desperate. Her daughter, however, refused and the doctor had a joint conversation with them.
I believe that there is a day set out for everyone and that one should not hope for it to come at your timing – but who cares about my believe? We all have our beliefs on different things, so who am I to judge.
Physicians and health professionals providing care for terminally ill patients confronts many ethical challenges. Baring this in mind, it requires physicians to be knowledgeable of the potential issues that might arise and strategies to avoid conflict when addressing those issues (Thomas & Cavalieri, 2001).
According to research, supporting patient decision making is an important part of patient-centered care and respecting patient autonomy. Thus, the patient must be the center of focus in all decision making when he or she is still able to participate in decision making. In addition, it is essential for physicians to have good communication and decision-making skills (Romo, Allison, Smith, & Wallhagen, 2017).
When involved in end-of-life decision-making the ethical principles need to be understood by physicians. The following ethical principles has been identified: autonomy, beneficence, non-maleficence, justice, and fidelity. The principle, autonomy could be seen as central to making ethical decisions in this matter. Autonomy calls for the patient to be the decision maker; the patient claims the right to self-determination (Thomas & Cavalieri, 2001). In this case my patient’s right to self-determination has been violated and the physician did not preserve this right of his patient. All she wanted was to die in peace; her daughter wouldn’t let her. I looked at her and I thought why she would let her mother suffer like that. After pondering the thought, I realized that I would’ve done the exact same thing.
Terminal illness puts heavy strain on families emotionally. This interfere with decision-making during this time and most of the time these family members go against the patient’s wishes and results in conflict between patient and family as well as amongst family members. This could be avoided through effective advance care planning. Advance care planning enhances communication between physician, patient and caregivers. It also guarantees that the patient’s wishes will be honored even at the time when the patient lacks decision-making capacity (Thomas & Cavalieri, 2001).
According to research Autonomy goes hand-in- hand with informed consent (Engelbrecht, 2014). Which means that we as health professionals have the responsibility to thoroughly educate our patients on certain treatments and procedures. If the patient refuses treatment one cannot force the patient to consent or treat them against their will. There was however, expected of me to persuade the patient to give consent. Which would mean violating patient autonomy.
This experience showed me that there was absolutely nothing I could do to change my patient’s mind or thinking, but I have learnt to not judge someone, especially when I haven’t gone through what they are going through. It caused me to change my view on euthanasia. I think that I would do the same for a close relative as we all human and sometimes struggle to let go. I knew that I can’t change the situation. I was however able to approach the doctor regarding the matter and he took it further.
References
Engelbrecht, S. (2014). CAN AUTONOMY BE LIMITED – AN ETHICAL AND LEGAL PERSPECTIVE IN A SOUTH AFRICAN CONTEXT? Journal of Odonto-stomatology, 34-39.
Romo, R., Allison, T., Smith, A., & Wallhagen, M. (2017). Sense of Control in End-of-Life Decision-Making. J Am Geriatr Soc., 70-75.
Thomas, A., & Cavalieri, D. (2001). Ethical Issues at the End of Life. JAOA, 616-622.
3 thoughts on “Grant me my last wish”
Thank you for sharing this piece of writing with us. I think you did an amazing job with this writing.
Your writing was easy to follow with well constructed sentences. The way you painted the picture of what happened was excellent as I immediately understood the delemma you and the patient was in.
You also managed to refer back to literature nicely to back up what you should be doing in these situations and how the patient should have the right to decide on where and how they should recieve treatment.
I’ve seen one or 2 spell and grammer mistakes which you could fix up.
However, I can only applaud your effort on a job that was well done
Dear Tameron, firstly thank you for sharing your piece. I must say I truly commend you for being able to see this patient, with such empathy despite how personal it actually was to you. Although it was difficult, you put your patients needs before your own and that is a characteristic every health practitioner should possess, well done!
content: your content Is good, well written. your topic was well chosen and related to the instructions given. your research carried out was well done and supported your content, it enhanced the topic and made the piece more realistic. The fact that you related your piece to a personal experience just made it so much more realistic and heart breaking, it truly brought about some tears. I especially like your introduction how you explained the good parts of the day and then the not so good parts, it is introduced as an emotional roller coaster so to say and it gives emphasise to not only your day but any persons day, we have ups and downs, and that just makes it more relatable. your research done on the patients decision making, and making the patient the center of focus is relevant, however it could enhance the effectiveness of your piece if your could perhaps relate the current situation to the reference, example explain a bit more how the patients needs was not put first and how the patient was not the center of the decisions which were made.
grammar – your writing is good however it has a few grammatical errors listed below
paragraph 1 – line 1, ” 10 may” should be 10th of May
line 5 , I would be stand a better chance , the “be should be removed”
line 7 =, “no and that is final”. – the no should start with a capital letter, there should also be a comma after the word no
paragraph 2 : line 1 – It was exactly one month and five days when I, should be , “It was exactly one month and five days ago, that I had..”
line 2 – questions to her hand, are you trying to say “took her hand” perhaps ?
paragraph 3 – but who cares about my believe, could be changed to who cares about my beliefs or who cares about what I believe.
paragraph 4 , line 1 – confronts should be confront, baring should be bearing
last paragraph – line 1 – interfere should be interferes
line 2 – patient’s wishes and results in conflict , after wishes you could add the word “and this”
references: Your references are relevant, and correctly referenced. Good use of in text referencing.
Good piece of writing, despite some minor changes. commendable effort.
all the best for preparation of the final piece.
Hi Tammy, thank you for your piece. I really enjoyed reading it and it made me think about how easily we can violate a pt’s rights without ever even realizing it.
Just a few thoughts:
1 – There are some minor spelling and grammar errors that need to be corrected.
2 – In your first two paragraphs you are creating context, however I would advise you to read through it again to ensure that your wording flows better, so that the reader can follow it clearly.
3 – I like that you referenced so many aspects of our module and incorporated it into your writing piece.
Overall well done, you definitely got me thinking.