Hospice care is a specialized form of care given to terminally ill patients at the end stage of their life (National Cancer Institute, 2011). This care is designed to focus on comfort rather than cure. The goal of the care is to adequately attend to the patient’s physical pain and mental suffering. In order to better relieve their suffering, pain medication is often used. However, ethical issues behind the use of pain medications in both hospice and palliative care have been globally debated. According to Douglas, Kerridge, and Ankeny (2008) a major issue that persists is, “the fear that the use of analgesic or sedative medications will hasten death” (p. 166). This may include the overdose of patients, especially in the mentally or terminally ill patients, who cannot express the severity of their pain.
The exact administration of analgesics and sedatives that are given to relieve the suffering of terminally ill patients are often times hard to determine because these drugs have a “double effect” (LaDuke, 2006). This is when the medications that are meant to ease and relieve terminal pain cause deterioration of the vitals, speeding up the end of life. According to LaDuke (2006), “studies have found that many physicians have trouble on a moral level distinguishing between administering medications that might hasten death to giving drugs that hasten death” (P. 165). If unskilled, unlicensed, and uneducated providers are hired in long-term care facilities to distribute pain medications to hospice patients, not knowing the side effects or even the effects of the medication itself, they could end up hastening a patients death.
Over the years, long-term care and end-of-life care has become very expensive. In order to accommodate to the increase in price, facilities have found ways around state restrictions and regulations. In doing so, many facilities have hired unskilled men and women. These care providers don’t know the first thing about the medications they administer or the side effects and symptoms of the drugs. They also don’t know how to accurately assess pain. By hiring unprofessional and unskilled workers to care for our elder generation, in order to decrease expenses, has overall decreased the quality of long-term health care.
In order to improve the quality of long-term health care, I propose that the federal government passes a bill that increases the hours of training for all workers, especially those who provide care to terminally ill patients, before the administration of drugs and the assessment of pain. I believe that before any nurse, doctor, or other health care professional administers medication they should be properly educated about pain management and hospice care. They should also be properly educated on the different kinds of medication that are administered, and there side effects and symptoms. The increase in education and training will increase the quality of care. In addition, it will lower the cost spent on sending patients out of the facility and to hospitals because of medication overdoses or horrible side effects that unskilled workers are not catching (P. Beilfuss, personal communication, March 20, 2011). It will also increase the access for any terminally ill patient to receive picture-perfect care.
Anyone who needs long-term care or end-of-life care should feel confident that those who provide it have the required knowledge, training, and skills. I also propose that all states regulate all long-term care facilities in order to have appropriate oversight and leadership. These elderly men and women deserve to be able to easily access good quality end-of-life care. The Wisconsin Board on Aging and Long Term Care believe that long term care consumers have the right to be treated with respect and dignity (Board on Aging and Long Term Care). In addition according to Horazdovsky (2009), “these individuals have lived productive lives, defended our country, and raised today’s leaders. Yet they are, at worst, threatened to be left behind or forgotten.”
-Written By Amber Wesela
Board on Aging and Long Term Care. Advocating for Residents Rights. Retrieved from http://longtermcare.wi.gov/subcategory.asp?linksubcatid=3001&linkcatid=1953&linkid=1014&locid=123
DOUGLAS, C., KERRIDGE, I., & ANKENY, R. (2008). MANAGING INTENTIONS: THE END-OF-LIFE ADMINISTRATION OF ANALGESICS AND SEDATIVES, AND THE POSSIBILITY OF SLOW EUTHANASIA. Bioethics, 22(7), 388-396. doi:10.1111/j.1467-8519.2008.00661.x
Horazdovsky, D. J. (2009, June 23). Long-Term Care is Vital Aspect of Health Care Reform. Retrieved from http://www.rollcall.com/news/-36168-1.html.
LaDuke, S., 2006. Attending Death with Dignity. In F. Mullan & E. Ficklen (Eds.), Narrative Matters (pp. 161-167). Baltimore, Md: The Johns Hopkins University Press.
National Cancer Institute. (2011). Hospice Care. Retrieved from http://www.nlm.nih.gov/medlineplus/hospicecare.html.
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