PHT402
ETHICS ASSIGNMENT: CIRCLE OF LIFE
The painting above known as ‘The cycle of birth and death’ by Symarani Dasi, discusses four main concepts: birth (life), disease, old age and death. It is based on spiritual world in the Indian culture of ISKCON (International Society for Krishna Consciousness), which is based on the Hindu scriptures. The practice of Bhakti yoga is focused on pleasing Krishna, their supreme lord (the sources of all the avatars of GOD). A.C. Bhaktivedanta Swami Prabhupada the founder of ISKCON was Syamarani Dasis’s spiritual master and later Srila Prabhupada taught her the philosophy of Krishna consciousness and bhakti yoga. This was the inspiration to over 200 of her paintings, including The cycle of birth and death. (Grunstein, n.d.) (Bhaktiart.net, n.d.)
In the painting the dark skeleton symbolizes death whereas the woman in white represents birth and life. The cycles of life and death is represented through the 11 human figures next to the skeleton and white woman. It shows the aging from birth, childhood, teenager, early adulthood, adult, elderly and finally to death. The animals with the human facing his back towards us represent the phases which everyone passes to finally become human. The infinity sign symbolizes the continuity of life. (Bhaktiart.net, n.d.)
The painting represents life and death. It is a cycle that everyone goes through. No one can avoid the inevitable death. The people aging from birth to death represent the life of the patient. In this lifetime death comes to play with ageing and disease, which is part of the cycle. In my opinion death should be taken into consideration when looking at the moral aspect of treatment in patients on their death bed. Life is something that all of us experience. Even though not everyone goes through every phase, we as health professionals should consider the patient, whether it is in ending suffering or saving their life for another day. Health professionals often play the role of God, which leads to prolonged suffering of the patient instead of letting life takes its course. In addition to suffering of the patient, this prolonged extension of life has a toll on the family as well, possibly giving a false sense of hope ending in tragedy.
In my clinical practice, general block, I came across a situation questioning an ethical dilemma. In the last week of the block, I had a patient that suffered from a stroke. The stroke was quite severe and had left her completely impaired on the one side of her body. She also suffered from heart conditions, worsening her condition. Initially she responded well to treatment, until one day. I was busy with my exam patient which was placed in the bed next to hers. Throughout the whole morning I listened to her breathing that gradually worsened throughout the day. By the time I had came to treat her, she was non responsive. I spoke to the doctor looking after her when I was informed that she has been listed as a non-resuscitate patient. As I started with simple passive bed mobilizations her breathing deteriorated. I considered suctioning her lungs to improve her breathing, but was told not to, as she started showing signs of Cheyne-stokes breathing.
Cheyne-stokes breathing is an abnormal pattern of breathing characterized by apnea and hyperventilation. It consisting of an increasingly deeper breathing pattern followed by periods where the breathing becomes more shallow and eventually lead to apnea (ceasing of breathing), when the cycle restarts and continues. Each cycle can last between 30 seconds to 2 minutes. It is also known as the end of life breathing pattern. It can occur suddenly or last over an extended amount of time, lasting hours and even days. The disorder is associated with heart failure and strokes. Patients presented with the Cheyne – Stokes respiration and heart failure usually predicts a negative outcome and increasing risk of sudden cardiac death. (Rudrappa and Bollu, 2019).
The Cheyne-stokes breathing continued for 10 minutes where there was constant doubt whether she was still alive or had died. Throughout those 10 minutes I constantly tried to feel a pulse, when at the end she had her final breath and died right in front of me. The death was confirmed by the doctor when her daughter walked into the ward. The daughter said to us that her mother had told her the previous day that she will be going home (heaven) tomorrow.
Life sustaining treatment is described as any type of medical intervention, technology, procedures or medication that is given to a patient to prolong life. In order to withhold treatment a person has to be actively dying with an existing condition that stipulate that CPR ( cardiopulmonary resuscitation) will have a great probability to be ineffective or a successful CPR leading to a poor quality of life which is not in the best interest of the patient. (Salins, Pai, Vidyasagar & Sobhana, 2010)
According to (McQouid-Mason, 2013). ‘Do not resuscitate’ (DNR) orders is defined as a situation of a “passing nature in terms of time” , saying that the patient was left to die naturally. DNR orders solely includes not giving CPR and not to terminating other treatments such as pain relief, medication and nutrition. The treatment however is futile, meaning that it is useless, ineffective and there is hardly a possibility of recovery or improvement.
The ethical dilemma comes in with where is the line in moral treatment of a patient? Where do a team of health professionals draw the line and stop treatment? Where does letting a patient die in peace comes in rather than receiving treatment till death? This was not the first time that students were given patients that were on their death bed, expecting us to treat this patient or suctioning lungs where the family and doctors (with the non-resuscitate consent) have already accepted the fate of the patient. My patient was listed as a DNR, non- responsive patient and presented with cheyne-stokes breathing. I was still told to treat the patient regardless of the state of her condition or even considering that the treatment will be futile and maybe not in the best interest of patient comfort . Even though the Constitution and National Health Act states that even with a DNR order a patient shall receive treatment, does that not only include medication to lessen pain and let life takes its course, which exclude extensive treatment such a therapy or should we as all health professional continue treatment as normal and pay no attention to a DNR order in terms of treatment? There is currently no right answer for this as the topic is still very controversial and there are no clear answer available. In my opinion I feel that we should show more empathy towards patients, taking into consideration their feelings, situations and experience throughout the process as well as what is best for the patient. Treatment should be given when it is in the patient’s best interest or to their wishes, but not when it is forced upon them though laws even if it will result in death.
By Cecile Louw, 2019
(3759751)
Picture retrieved from:
Bhaktiart.net. (n.d.). Bhakti Art | Spiritual Krsna Art & ISKCON Paintings & Giclee by Syamarani Dasi (Jadurani dasi) | Krishna Art | Cycle of Birth and Death. [online] Available at: http://bhaktiart.net/hp_wordpress/?dt_portfolio=cycle-of-birth-and-death [Accessed 25 Aug. 2019].
References:
Bhaktiart.net. (n.d.). Bhakti Art | Spiritual Krsna Art & ISKCON Paintings & Giclee by Syamarani Dasi (Jadurani dasi) | Krishna Art | Cycle of Birth and Death. [online] Available at: http://bhaktiart.net/hp_wordpress/?dt_portfolio=cycle-of-birth-and-death [Accessed 25 Aug. 2019].
Grunstein, G. (n.d.). Windows To The Spiritual World. [online] Yogi Times. Available at: https://www.yogitimes.com/article/syamarani-dasi-devotional-paintings-artist-art-painter-india-spiritual-download [Accessed 23 Aug. 2019].
McQuoid-Mason, D. (2013). Emergency medical treatment and ‘do not resuscitate’ orders: When can they be used?. South African Medical Journal, 103(4), 223. doi: 10.7196/samj.6672
Rudrappa, M. and Bollu, P. (2019). Cheyne Stokes Respirations. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK448165/ [Accessed 22 Aug. 2019].
Salins, N., Pai, S., Vidyasagar, M., & Sobhana, M. (2010). Ethics and medico legal aspects of “Not for Resuscitation”. Indian Journal Of Palliative Care, 16(2), 66. doi: 10.4103/0973-1075.68404
4 thoughts on “Circle of life”
Well written piece. I enjoyed reading your interpretation of the artwork and how it linked to the ethical dilemma you experienced during Clinical Practice. This piece helped me to gain an understanding on when enough should truly be enough, and when is it time for the health professionals to take a step back. Although the piece was quite well I came across a few errors: in the 4th paragraph “quiet” should be spelled as quite, additionally some tense errors were made. The link between an ethical dilemma and your clinical practice experience could have been better explained. I say this as your clinical experience was adequately portrayed and gave insight into what you experienced, but the link to a specific ethical dilemma was not as emphasized. Furthermore, the questions posed at the end of your piece give the reader the sense that a new resolve is to be found. In my opinion, for the piece to have resolve these questions could be answered by you through the use of articles explaining ethical practices perhaps? Thank you for sharing your clinical experience with me
A well written piece. I really enjoyed reading how you intergrated the art piece with your person clinical experience and how that experience lead to an ethical dilemma. The artwork gave me a full understanding of something that is most certain for all of us being death. The way you integrated that idea of death with your clinical experience made me understand that even some of our own patients will die even though, as health professionals, we are trying our best to prevent death. The questions you put up on the last paragraph gave me the impression that these are questions that have not really been answered making it a very mysterious topic amongst health professional. In my opinion, I would like to read more about what you have learnt from the clinical experience and how this experience has changed your view on this topic. Do you believe that we should leave patients to die by their own will or should we as health workers ignore a patient’s wishes and do whatever it takes to keep the patient alive?
Hi Cecile, thank you for sharing your reflection with me. Your piece really encompassed an ethical dilemma that many health professionals have been exposed to. The painting created an imagery of what the cycle of life is and the link you created was well written. Your clinical experience was one that every health professional hopes never to experience yet it does happen.
I do feel that when a patient signs a DNR that they should also state to what extent they will like to be treated as some techniques do affect the palliative care approach that is known following a DNR.
The use of many references assisted to make your reflection evidence based as well as experience based, well done.
The 3rd paragraph’s first few sentences could be combined into as they are following statements. Additionally, in the 4th paragraph the spelling of non responsive should be hyphenated.
Overall, I thoroughly enjoyed being able to read about your experience and the link between the painting and your experience was well done.
Hey Cecile. I like how artistic and informative your piece is. However,I feel like if a patient is still alive they still deserve treatment that will make them better in any way no matter the severity of the condition. I’m saying this because I have had a patient who was very weakened and I always felt like my treatment was just wasting his time considering his attitude as well,I managed to work with the patient for two weeks and on the third he was getting way better and able to at least stand. Same way as I have treated patients that were doing very well and died the following day like they were not well the previous day.