ournal Reflection #1-3

1. Discuss your thoughts about the article, who should pay the cost of care for preemies, and why.  (150 words, 10 pts)
2. Should cost of care be considered in determining value of life-saving treatment for patients? (250 words, 10 pts)
3. Should an individual’s level of function be considered in determining life-saving treatment for patients? If so, who determines what “level of functioning” should be? (250 words, 10 pts)

Journal Reflection #4-5

Palliative care and hospice care provide dignified and supportive care during chronic illness and the dying process. Palliative care focuses specifically on providing supportive care for patients during chronic illness. This could include, but is not limited to, pain and symptom management, family support, art and music therapy, etc. It is ongoing comfort care for both patient and family in both inpatient and outpatient settings.
Hospice care is more specifically targeted for end-of-life care, typically during the last six months of life. Hospice care is most often delivered at home, allowing the family to care for their loved one in the home until death. There are inpatient hospice facilities; however, patients typically residing in this type of facility have very little time remaining.
The goal for both palliative or supportive care services and hospice is to provide comfort and dignity during chronic illness and death. Not all patients who are a part of a palliative care program will be a part of a hospice program. With today’s rapidly advancing medical developments, many people live long lives with chronic illness. Hence, the true-shared purpose for both palliative care and hospice is supporting the patient and family. Medical professionals have the privilege of sharing the most difficult and vulnerable times with their patients. To do this well, a medical professional must seek to understand how to provide dignity and respect to every patient, every time.

1. How can you provide dignity and respect to a patient? (150 words, 10 pts)
2. What does it mean to die with dignity? (150 words, 10 pts)

Journal Reflection #6

When discussing death and dying issues personally or professionally, there is great potential for disaster. This is because everyone views death, dying, dignity, value, and life differently based on their worldview, culture, and presumptions about life. As a medical worker, you must be able to set your assumptions aside and seek to advocate for your patient’s preferences. In the inpatient setting, an ethics consult can be helpful during times of disagreements between medical staff, family members, or staff and family.
Ethics consultations should be initiated when an ethical problem exists in the care of a patient. Communication can be very difficult during these times; an ethics consult can help by bringing in an outside, third-party perspective about the situation. If a communication breakdown is not the issue, there can be a true ethical decision that needs made. Actual ethical principles of autonomy, beneficence, or justice can be debated. For instance:

• Should a patient unable to breath on her own or who has been “trached” and ventilator-dependent be allowed to die?
• Should a patient have a feeding tube placed to sustain life when no signs of continued neurological development exist?
• Should a patient be allowed to refuse chemotherapy and radiation, knowing the cancer will grow and end his life?
• Should a pediatric patient be transplanted against his will?

We could discuss endless types of circumstances where ethical decisions can be difficult to make. Ethics consults can be helpful in bringing clarity to the issue at hand, protecting the patient, and providing all possible outcomes to the situation. It is not the role of an ethics consult to make a decision. Instead, their role is to help clarify the question, problem, and all possible outcomes. An ethics consult can summon one person, an expert in ethics, to help with the ethical dilemma or it can summon an ethics committee. Ethics committees are multidisciplinary groups, including physicians, nurses, social workers, psychiatrists, educators, lawyers, administrators, and other people who have undergone advanced ethics training and education. Anyone can ask for an ethics consult.

1. Protecting patient’s autonomy is a primary role for the nurse. How can initiating an ethics consult protect a patient’s autonomy? (150 words, 10 pts)