Medicine
Pre hospital care – paramedic
This document outlines an analysis of the film “A Good Death” filmed at the Dunedin Hospital New Zealand. It was produced by Dr. Taylor who had a passion for end of life issues in patients with respiratory failure. This story embraced the turmoil of one of his patients, Martin Cavanagh.
Key features of the case
Key features of this case embody preparing to have a good death experience. Mr. Martin Cavanagh’s struggle was not only physical, but emotional. This emotional struggle apparently was transferred to his family who day after day just witnessed his agony. It would appear that after a while they felt helpless because they were not given options regarding how to best approach an end of life experience, which prologs over time (Taylor, 2013).
Dr. Taylor’s main goal for this film was to educate patients, families and healthcare providers regarding resources available for addressing end of life experiences encountered by Mr. Cavanagh and his family. Importantly, patients suffering with Chronic Obstructive Pulmonary Disease (COPD) are challenged with respiratory emergencies, which are life threatening. According to the pathophysiology of COPD patients die suddenly apart from experiencing a lengthy period of illnesses associated with respiratory failure (Taylor, 2013).
Unfortunately, Martin Cavanagh and his family were not prepared for this traumatic experience, initially. However, as was depicted in the film when they acquired the knowledge of resources available to them and their loved one they become more adaptable to the circumstances facing them as hospice intervention was introduced. It would appear, though, that this might have been too late since they were almost exhausted with by the agony of this dying man to do anything else, other than prepare for a funeral and burial (Taylor, 2013).
Two legal considerations
Two legal considerations relate to first who makes the decision of stopping, Martin Cavanagh resuscitation treatment; secondly, whether the doctor can take responsibility without consent from the patient/client or legal surrogate to resuscitate. Martin Cavanagh, case was complicated since his wife was not he mother of his children. As such, while he was placed in hospice a conflict of interest might have emerged in the grieving process (Taylor, 2013).
Advance directives are legal documents, which ought to be considered in an end of life situation whereby family members may not agree on what a loved one may require should he/she become unconscious or in any other way incapable of making a decision about further treatment or care. These include making a living will; providing a do not resuscitate order as well as withholding or withdrawing treatments order (Lewis, 2007)
Living wills explain how the desires of hospice patients such as Martin Cavanagh are to be executed during their end of life care. It includes a directive to the physician (DTP); durable power of attorney for health care (DPAHC) and a medical power of attorney (MPA). These directives could limit controversies arising among family members during Martin Cavanagh’s end of life care (Lewis, 2007).
Two ethical considerations in the case
Dr. Taylor when faced with the challenge of continuing Martin Cavanagh’s respiratory treatment disclosed two major ethical considerations facing him as a physician. First and foremost was his responsibility to persevere life. Next was the issue of prolonging death. Hospice care focuses on palliative intervention. The ethical contention is whether this palliative strategy is sustaining life; prolonging death or assisting death (Foley & Hendin, 2002). However diverse the interpretations hospice specialists argue that ethically interventions are intended to provide comfort; maintain human dignity and tranquility during the end life stages of death (Lewis. 2007).
Further ethical considerations responding to criticisms of these strategies explain that end of life is not a medical experience, which doctors can treat palliatively. Therefore, ethically patients with terminally diagnosed conditions ought to die a good death free of agony and suffering. In modern societies this care is extended beyond hospitals, nursing homes or assisted living facilities. Patients are allowed to be cared within the confines of their home among family members, which is considered more ethically desirable (Lewis. 2007) .
Reflection on management of cases
In my opinion the case was management efficiently by paramedics. They took into consideration that they were caring for a dying patient who was not only experiencing physical pain and discomfort, but emotional ones too. They could have acted as if it did not matter because he was going to die anyway if not from respiratory distress from the terminal condition. Paramedics stood to the task of preserving life instead of prolonging death (Lord et.al, 2012).
In reflecting on whether the communication between paramedics and other people involved was adequate inevitably reference to Rosenberg’s (2013) study must be made. He emphasized that patients with life-threatening conditions often need emergency care many times during their prolonged illness. Consequently, paramedics ought to respond professionally extending high-quality palliative care whenever and wherever the emergency occurs. Importantly, it must be noted that twenty-first century evolutions within the science has placed paramedics in the front line as first responders to hospice patients experiencing an emergency requiring cardio pulmonary resuscitation (Rosenberg et.al, 2013).
As such, in responding to Martin Cavanagh’s emergency it is my duty to act responsibly by executing the knowledge and expertise available to me in promoting comfort and relief in an end of life crisis. According to Smith‘s (2009) group of researchers ‘attitudinal and structural barriers may need to be overcome to improve palliative care in the ED; despite targeted recruitment, attending physician participation was low’ (Smith et.al, 2009, pp 7).
Therefore, my management of this case will consist of adherence to emergency protocol of a patient in respiratory distress. McNamara (2013) and team advance that early admission to community based palliative care limits use of emergency departments and reduces death within 90 days of the emergency. As such, soon after addressing the respiratory distress emergency it would be advisable that Martin Cavanagh receive community based palliative care (McNamara et.al, 2013).
References
Lewis., M. (2007). Medicine and Care of the Dying: A Modern History. Oxford
Lord, B., Récoché, K., O'Connor, M., & Yates, P. (2012). Paramedics' perceptions of their role in palliative care: analysis of focus group transcripts. Journal of palliative care, 28(1), 36.
http://search.proquest.com/docview/1000455483/fulltextPDF?accountid=10910
Foley., K & Hendin., H (2002). The Case Against Assisted Suicide: For the Right to End-of-life Care. JHU Press
McNamara, B. A., Rosenwax, L. K., Murray, K., & Currow, D. C. (2013). Early Admission to
Community-Based Palliative Care Reduces Use of Emergency Departments in the Ninety Days Before Death. Journal of palliative medicine.
http://online.liebertpub.com/doi/pdf/10.1089/jpm.2012.0403
Rosenberg, M., Lamba, S., & Misra, S. (2013). Palliative medicine and geriatric emergency
care: challenges, opportunities, and basic principles. Clinics in geriatric medicine, 29(1), 1-29.
http://www.mdconsult.com/das/article/body/412099455-
2/jorg=journal&source=&sp=25901213&sid=0/N/1114973/s0749069012000869.pdf?issn=0749-0690
Smith, A. K., Fisher, J., Schonberg, M. A., Pallin, D. J., Block, S. D., Forrow, L., Phillips, R. S., & McCarthy, E. P. (2009). Am I doing the right thing? Provider perspectives on improving palliative care in the emergency department. Annals of emergency medicine, 54(1), 86-93.
http://www.sciencedirect.com/science/article/pii/S0196064408016478
Taylor., R (2013). A Good Death. Film
