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Clinical Practice Guidelines for Quality Palliative Care

Clinical Practice Guidelines for Quality Palliative Care

Introduction

According to the National Consensus Project for Quality Palliative Care, the numbers of people that are suffering from life threatening diseases is increasing (2014). This increase has been attributed to the increased longevity in the population as a result of the recent advancement in technology. As a result, there is more need for palliative care in the population. Palliative care, which was introduced in the USA three decades ago, is an offshoot of the interdisciplinary hospice model of care that focus on holistic team-based care of the patient. The Interdisciplinary teams give attention to the physical, psychological, motional, and social needs of the patient. This holistic client-based approach is gaining popularity and is being increasingly applied in healthcare and hospice centers. When dealing with patients that need palliative care there are several things that the IDT team needs to cover in detail with the client. Among these issues include the practical necessity of the living will, the relationship between palliative and recuperative care, the application of euthanasia, and meeting the social and spiritual needs of the clients and their families. This essay will extrapolate on these four issues and expose their relationship to palliative care.

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Practical Necessity of the Will and Living Will

The will, especially the living will, avoids many unnecessary and harmful consequences to the friends and family of people that are terminally ill, and who are preparing for an imminent death. These consequences are of different natures, i.e., financial, psychological and medical. Therefore, by preparing a living will, an individual reduces the likelihood of the problems from taking place.

First of all, some of the potential and unseen potential financial problems that are avoided by having a will include problems associated with distribution of wealth after the death of a person. Cheeseman defines a will as a document that declares how a person’s property and wealth should be distributed in case they lose their lives (Cheeseman, 2007). As a result, unnecessary disputes as family and friends fight for the property are avoided. The will channels property to schemes and individuals that a person considers worthy to have their money. Therefore, the person writing the will should consider the things that are important to them and to their family members and include them in their will. The testator or testatrix can include anything that they desire in the will including money, assets, real estate, pets, and even children. As mentioned earlier, there could be disputes after the death of an individual between relatives as they fight for the deceased person’s relatives. For instance, according to the current laws, when a man dies without a will, all his property is automatically passed on to his wife. The other relatives may feel that the wife may have received too much wealth from the husband, leading to wrangles and law suits. To avoid such scenarios, an individual should prepare their will before they die.

The second problem associated with wills and inheritance that can bring financial problems on the family of the deceased is taxes. According to Monk and Hacker (2014), the death of the deceased passes on the responsibility of taxes to the next of kin. If the relatives had no prior knowledge of such financial commitments, they may get into financial hardships. However, there is a due process through which debts and taxes are paid before the rest of the wealth is distributed among the beneficiaries. This process is known as probate and cases of debts and taxes in the will are settled in a probate court (Finch, 2015).

The distribution of debts is another financial problem that confronts the friends and relatives of individuals who do not have a will. One individual that may be in trouble is the individual’s spouse. As mentioned earlier, the spouse inherits all the assets of the deceased. In case both parents die, the wealth is equally distributed to all the children. This is also the case in case there were debts. As a result, people inherit debts that they may not have any knowledge of, leading to financial difficulty for such individuals. To avoid such inconveniences, a person should write their will that includes the distribution of debts before they die. Therefore, it is important to know about wills and how wealth can be distributed to the beneficiaries in a will.

There are several ways in which wealth can be distributed in the will of an individual. The person writing the will is known as the testator if they are ale and testatrix if they are female while the individual that benefits from a will is known as a beneficiary. There are two types of wills based on whether they are handwritten (holographic wills) or spoken orally in the presence of witnesses (nuncupative wills). However, it is not every individual that can write a will because it is only people that are above the legal age that are allowed by the law to write valid wills. The will should clearly state who the beneficiaries are and the exact value of assets and debts bequeathed on the beneficiaries.

However, there are people that prefer to disburse their wealth to beneficiaries in small amounts, later on in life. This is especially the case when the beneficiaries are below the legal age. In such cases, the testator leaves their assets in a trust. Such trusts come in various forms. For instance, there are people who prefer the beneficiaries of the will to receive all the assets at once at a later point in their lives. On the other hand, there are individuals who choose to have their beneficiaries receive the assets over a period of time.

Secondly, there are also psychological problems that the family members and friends of a dying person without a will are likely to face. According to Cheeseman, a living will specifies the lifesaving measures that the signor wants taken and the treatments that they want withdrawn in case itreaches a point that there is no hope for recovery back to normalcy (Cheeseman, 2007). This living will gives the person a feeling of control and only passes on this burden to friends and relatives when the person can no longer make decisions for themselves. An example of situation that requires other individuals to make decisions on the behalf of the sick individual is in the case of brain death. Such a person cannot make decisions on their own and therefore require another to think and make decisions in their stead. Apart from the cases mentioned, individuals who are in a position to make their own decisions should have their own living wills ready at all times. This will give direction at times when relatives and friends have divergent views on what should happen. For instance, not having a will can bring great hardship on a person’s family, especially in the case when one relative wants the sick to be placed under a machine to sustain and prolong their life while the other relative thinks that the machines should be disconnected.

Lastly, concerning problems, there are medical problems that can affect individuals whose dying friend and family member do not have a living will. One of the problems that relatives and friends of sick individuals face is when to make the decision to resort to euthanasia and when to shift their mode of medical care. For instance, at what point should treatment cease and palliative care begin.

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Recuperative Medical Care, Palliative Care, and the Right to Cease All Care

Recuperative medical care refers to both the acute and post-acute medical care provided to homeless persons. These patients are usually not in a position to recover from their condition on the streets but are not sick enough to be in a medical center. As a result, recuperative care On the other hand, palliative care is the specialized and individual based medical care that is given to people suffering from serious illnesses. The main focus in palliative care is relieving the patient of the symptoms; especially pain; that accompanies the disease. Therefore, the goal of palliative care is to improve the patient’s quality of life. This treatment can also be accompanied with curative treatment. Therefore, recuperative care differs from palliative care in terms of duration of the care; with palliative care taking longer. Secondly, palliative medical care seeks to relieve a patient suffering from serious illness of the pain and symptoms while recuperative care is offered to the homeless people that require medical attention.

Based on their different approaches, there are patients that find recuperative care more suitable than palliative care. However, there are situations when it is possible to change the course of treatment of a patient from recuperative to palliative. The team that determines the best approach to treat and take care of the needs of the patient is known as the Interdisciplinary Team (IDT). Based on the conditions and state of the patient, this team decides on whether recuperative medical care or palliative care is most appropriate for the patient.

The Interdisciplinary Team (IDT) assesses and evaluates the progress of the patient constantly to determine the approach to use. This team carries out tests on the patient right from the onset. The initial evaluation determines the patient’s current medical status, adequacy and accuracy of diagnosis, and the treatment that should be used. The treatment prescribed should be consistent with the medical history of the patient; current diagnosis; and the patient’s past responses to previous treatment. The best and most comprehensive assessment identifies the four domains that determine the quality of life. These four domains are the spiritual, social, psychological, and physical aspects of care. The IDT should ensure that all the four domains are adequately covered so that the patient can have a holistic recovery.

There are certain periods in which it is clear that the medical attention given to patients in palliative care is unnecessary because the condition of the patient indicates that the patient is dying soon. This is especially the case when the patient is in the advanced stage of terminal illnesses such as cancer. At such a stage, it may be clear that the patient is dying soon. At this stage, the IDT should recommend the patient to palliative care so that they focus on relieving pain and alleviating the symptoms of the disease. On the same breath, the four domains mentioned earlier, i.e., social, spiritual, physical, and psychological aspects should not be ignored in the palliative care. This will give the patient a dignified and meaningful death.

Active and Passive Euthanasia

Kamal, LeBlanc, and Meier (2016), argue that the main aim of healthcare is the preservation of life. However, there are cases where it is beyond the ability of the healthcare professionals to preserve the life of the patient. At such times, the task of the healthcare professionals is to provide dignity and comfort to the dying patient, and give support to other professionals that are involved in this endeavor. There are several professionals, both within the medical profession and otherwise, that are involved in the decision-making process on end-of-life wishes. The communication of end-of-life messages may be hard for the IDT because it involves holding difficult conversations with the patient, family members, and friends. The professionals best suited for the communication of EOL messages include psychologists and psychiatrists. The main reason that psychologists and psychiatrists are best suited for passing EOL messages and handling EOL cases is the fact that they have training on the psychology of handling people and their responses to different situations. Therefore, they are equipped to handle EOL issues with patients and their families, given the fact that these issues are highly emotive and sensitive.

There are individuals that choose euthanasia over their loved ones when the condition of the patients is beyond any medical treatment. Fletcher asserts that Euthanasia differs from a simple cessation of treatment in the sense that it is a conscious decision to end the life of the patient. The patient, or their surrogate, decides that treatment will never work and therefore the patient starts preparing for their death (Fletcher, 2015). There are several characteristics that distinguish between euthanasia and cessation of treatment. First of all, euthanasia is a conscious decision that the patient is preparing to die and that the family and friends should be emotionally, financially, and psychologically prepared for the approaching death of their loved one. On the other hand, cessation of treatment involves stopping the healthcare plan that a patient was exposed to. This action may not be accompanied by major effects on the health of the patient and the well being of family and friends.

The second difference between euthanasia and cessation of treatment is the approach that doctors use to handle the patients and family. As stated earlier, euthanasia is a complex EOL issue and the patient and family should be prepared for this death. As a result, it involves a lot of counseling, both on the patient and their relatives. The counseling of the patient is meant to make the patient to embrace their last days as a gift and face death with dignity. On the part of the relatives, the counseling serves to cushion the family of the dying individual against stress and depression and accept the death. On the other hand, cessation of treatment does not involve this intensive counseling regimen. The counseling may not be necessary because the patient may not be in a serious medical predicament.

Given the weight and importance of EOL decisions, there should be individuals present when end-of-life decisions of a sick patient with no close relatives need to be made. This is especially the case when the sick individuals are not in a position to make these decisions themselves. For instance, there are cases when the patient is brain dead and is therefore not in a position to make important EOL decisions. Some of these decisions include the treatment plan to use, the writing of the will, and whether to resort to euthanasia.

The individual that decides on what should be done with the patient when the patient is not in a position to make such decisions is known as a surrogate. The surrogate can be a spouse or a close relative. Before the doctors carry out any important procedure on the patient, they have to consult with this surrogate first so that they can get a go-ahead. Some of the things that the Interdisciplinary Team consults with the surrogate include whether the patient should change their medical care plan and whether euthanasia should be used. Another issue on which the surrogate should be consulted is the religious and social activities that the patient can be exposed to. In other words, the surrogate acts as the mouthpiece and decision maker for a patient that is not in a position to communicate.

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Addressing Social/Family Needs and Spiritual/Existential Needs

According to Puchalski et al., patients have several intangible needs that should be met; social/family needs and spiritual/existential needs (2009). To take care of these needs, several measures need to be taken to ensure that persons maintain high quality family and social relationships, both individually and as a group, to end-of-life patients.

Actually, palliative care programs should serve the patient, his or her family, and the community at large in a culturally and linguistically appropriate manner. The term culture is broad and includes many facets. Some of these facets are values, beliefs, customs, actions, communications, thoughts, and institutions of a social, religious, ethnic and racial group. During the assessment stage, IDT should probe for and document the cultural features of the patient and the family such as concerns, strengths, and weaknesses. The IDT should be cognizant of the fact that cultural expression and identity is not fixed but it varies from family to family and within communities. Therefore, each and every patient and family should be treated uniquely based on their cultural identity.

However, these relationships can be broken if people do not take care of them with caution. Therefore, pitfalls that can cause the severing of these relationships should be avoided. Some of the pitfalls include biases, prejudices, and some community values of certain communities that all lead to value conflicts because different individuals value different things. For instance, there are religious denominations such as the Jehovah Witnesses that forbid blood transfusion. In case a patient from this sect requires blood because of an internal blood shortage, the doctors will be faced with difficulties on whether to conduct a blood transfusion or let the patient die. It is in such cases that the living will comes in handy. The IDT will follow the directions that the patient outlined in their living will to avoid such conflicts.

A second example of a pitfall that can severe relationships is biases and prejudices. An example of such a bias is the widespread bias against women professionals in some communities. As a result, the individuals from these communities may find it difficult to have female physicians and nurses attending to them. To avoid such conflicts, the people who hold such biases should be attended to by the staffs of their preference.

On another note, the patients also have spiritual and existential dimensions that should be respected and integrated into the process. To make this proposition a success, there are several actions that should be taken to ensure that the parameters are met. The National Consensus Project for Quality Palliative Care identify spirituality as the intrinsic aspect of humanity that guides and shapes the way in which people seek and express their conception of meaning and purpose. Spirituality is expressed in several ways including the relationship and connectedness of persons to the moment, to the self, to other people, to the natural world, and to anything else that they hold as significant and sacred. For instance, there are groups that prefer to display their religious symbols such as the cross and the Bible in the case of Christians. The National Consensus Project for Quality Palliative Care further proposes that it is the responsibility of health professionals to identify cases of spiritual distress. After identifying these cases, the professionals should attend to these needs, because it is within their scope of practice. For instance, some of the patients may believe in the existence of an afterlife where people are held accountable according to their conduct in this life. This individual may feel that they need to make propiation for their faults before they pass on to the afterlife after they die. As a result, the individual may choose to repent of their sins before they die. It is the duty of the health professional to lead them in this task so that the patient can die a satisfied person.

Concerning the spiritual and existential needs of the patient, the healthcare professionals should not impose their personal convictions and religions on the patients and their family members. This may be insensitive and uncouth, especially to the patient. The interdisciplinary palliative care team, at all times, should include a chaplain that attends to the spiritual needs of the clients. This chaplain should also have the acumen and expertise to address and assess the spiritual and existential needs of their clients. This will ensure that all the spiritual and existential needs of the patients will be met by an individual that is qualified, experienced, and well suited for these types of needs.

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Conclusion

With an increased demand for palliative care, healthcare professionals are forced to provide better services to their clients. Consequently, there is more research into this field with better approaches being devised. One of the popular and effective approaches to palliative care is the holistic method that emphasizes on four facets; the psychological, social, physical, and spiritual domains of quality palliative care. When these aspects of care are addressed, the result is better satisfaction from patients and relatives as well as patients facing their death with courage and dignity. The IDT is also increasingly becoming open about end-of-life decisions for the patients that are suffering from life-threatening illnesses. As a result, many patients are facing their deaths courageously and are leaving behind relatives and friends that can cope with their deaths. This is a result of the inclusion of the social and spiritual aspects of care into palliative treatment plans. There is sufficient evidence to show that the best approach to palliative care should be holistic. Another issue that is important is resolving the will before a patient dies so that they can avoid unnecessary problems to their next of kin after they pass on.

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