Final Research Paper- Conclusion

There is a need to talk about the inevitable consequence of death. We will not always agree on what to do in such tragic events, yet we do need to start an honest dialogue about what is essentially, the ultimate rite of passage.
What have we learned about life, ethics, and life-sustaining treatments from the Terri Schiavo saga? Surely the biggest lesson derived from the Terri Schiavo case is that of advance care planning and its inclusion in public discourse. Even well-drafted legislation is not always able to deal effectively with the consequences of family feuding motivated by financial, religious, and political considerations. Ultimately it is the healthcare professional’s responsibility to carefully consider the patient’s healthcare wishes and convey them in a clear and timely manner.
The Terri Schiavo case opened the door for discussion of living wills in many homes across America. Husbands and wives began talking over dinner about their own end of life wishes. People were compelled to get their living wills in order and voice their wishes to their loved ones. Though the Terri Schiavo case got Americans talking about important personal issues, it is unfortunate that Terri’s life has been memorialized not by the person she was or her accomplishments, but by her controversial and sad death.

Final Research Paper-Intro

Advances in medical technology has allowed for and contributed to an increase in human life expectancy. Physician’s prognosis’ for a variety of diseases has shifted from a poor or fatal outcome to the possibility of complete or partial recovery. The ability to prolong and sustain life can be viewed as either a positive medical advancement or an open door to a multitude of ethical issues. Prolonging the life of a patient awaiting an organ transplant or a cure for a disease is ethically appropriate, if the patient’s quality of life during that time is good. However, keeping a patient alive, using a life sustaining treatment, that has a poor quality of life or resuscitating a terminally ill patient is unethical. Determining what is considered a poor quality of life, versus an acceptable quality of life, and the use of life-sustaining treatments, along with the enforcement of advanced directives have become a powerful and controversial topics in the medical field.
These issues were exemplified in the Terri Schiavo case, in which a young woman diagnosed as being in a persistent vegetative state, was thrown into the middle of a lengthy legal battle between her parents, her husband and the medical team involved with her care. Terri was twenty-six years old when she collapsed in her Florida home in 1990. Her treating physicians believed a potassium deficiency caused a heart attack in which Terri suffered catastrophic brain damage, resulting in a persistent vegetative state (PVS). A percutaneous endoscopic gastrostomy (PEG) tube was placed to provide nutrition and hydration for Terri. PEG tube feeding, which is commonly used as a life-sustaining treatment, was Terri’s only means of survival. Since the day the PEG tube was placed, a long and protracted legal battle ensued, encompassing Terri’s life, removal of her feeding tube, and bitter family disputes concerning her quality of life. In essence, the case turned into a legal battle between Terri’s husband, the medical professionals involved in her care, and Terri’s parents. Throughout the drawn-out legal proceedings, that lasted more then a decade, Terri lay in numerous long-term care facilities, possibly in pain and discomfort, possibly pain-free and comfortable, yet with a very poor prognosis (Breier-Mackie 293).

Reference:

Breier-Mackie, Sarah J. PhD, RN, APRN. “PEGs and Ethics Revisited: A Timely Reflection in the Wake of the Terri Schiavo Case.” Gastroenterology Nursing. 28 (2005): 292-297.

Today the weather man predicted rain. Of all the days to rain, it had to be today. It just wasn't fair. Today the principal of the high school was to trek across the football field to the altar to accept the blue stationery he had won. It's raining and windy and there is not a right handed person in sight. I'm not sure who's responsible for altering today's plans. Or whether or not it was the rain that affected today's ceremony. Two people were very upset about the rain so they decided to write a letter but it had little effect. Their writing skills are poor and they're citing references all wrong, except for one. The letter was just too much for your average paper carrier to hold. The mail carrier had a flat affect and began to lose his temper. He loosened his tie and screamed, "I challange you to a race around the track!" The mail man's anger effected the crowd negativily. The angry mob shouted back , "you're going to have to pay a fare for standing stationary for so long!" The crowd lost its site for the initiation rites ceremony. They didn't stick with their moral principles, so whose at fault? I don't know.

Expository or Persuasive

My research paper is certainly heading down the persuasive road. Simply because my paper revolves around ethics, gives it an argumentative feel. It's difficult to be in the medical field and not have an opinion about end of life decision making and all that it involves. Though I am attempting to be as unbiased as possible and just present the facts. I would rather give facts, figures, and explanations that allow the reader to make their own, informed decision on the matter.

With that in mind, I think my paper could also be categorized as expository. In order to explain medical terminology and certain cases involving my topic, it is necessary to include facts and information further explaining my topic.



cartoon obtained at:
http://www.research-for-real.co.uk/resources.asp

Factors Used by Physicians to Determine Code Status

The incidence of withholding and withdrawing life support from the critically ill dying in an intensive care unit has increased to 50–90% of patients in recent years. At the same time, objective prognostic information to assist in decision-making, and care of dying patients are lacking.

Deciding factors of withdrawing life support include likelihood to survive the current episode and long-term survival, patient’s age, previous cognitive function, and poor expected quality of life (QOL). Other factors comprise hematological malignancy, neurological or circulatory reason for admission, length of stay, and previous physical health.

Serious concerns have been raised concerning the validity of physicians’ perceptions of patients’ QOL, the miscommunication between patients’ and their families’ decisions, and physicians’ ability to assess prognosis correctly. Moreover, a discrepancy exists between physicians’ opinions and public opinion regarding end-of-life decision-making. In addition, long-standing interventions, and expected time of death influence the decision to withdraw life support.

Reference:
Pettila, V., T. Ala-Kokko, T. Varpula, J. Laurila, and S. Hovilehto. "On What are Our End-of-life Decisions Based?" Acta Anaesthesiologica Scandinavica 46 (2002):947-54.

Cartoon obtained at:
http://www.jwolfe.clara.net/Humour/Doctors.htm

EMT's and Out-of-hospital DNR's

EMT's (emergency medical technicians), provide rapid response and treatment to patients in cardiac arrest or with other life-threatening conditions. EMT's also transport seriously ill patients between nursing homes and hospitals. All patients are considered a Full Code (desire resuscitation and life prolonging interventions), unless the EMT's are given explicit information to the contrary. If during transport a patient requires heroic measures to save their life, it is the EMT's responsibility to perform basic and advanced life support procedures. Unfortunately, EMT's are often called for their transport services during an emergency and the patient generally doesn't have the ability to state their wishes. And many patients with advanced illnesses may not want all of the interventions offered by the EMT's.

Out-of-hospital do-not-resuscitate (DNR) orders have been developed to provide EMT's written orders regarding resuscitation. In general, out-of-hospital DNR policies specify circumstances under which EMS providers should withhold attempts at resuscitation for pulseless and apneic (breathless) patients. For example, Connecticut has a program using DNR bracelets. The program specifies that EMTs must honor these DNR orders and provides immunity from liability for honoring the order. A recent study found that 89% of a national sample of EMTs was willing to honor a state-approved DNR order.

Reference:

Schmidt, Terri, MD, MS, Susan Hickman, PhD, Susan Tolle, MD, and Heather Brooks, BS. "The Physician Orders for Life Sustaining Treatment Program: Oregon Emergency Medical Technicians' Practical Experiences and Attitudes." Journal of American Geriatrics Society 52 (2004): 1430-34.

Picture obtained at:
http://www.allposters.com/-sp/Emt-Posters_i914019_.htm

The Other Side

Though I do believe that those suffering from a terminal illness should have the right to die, I do agree with a few of this articles points on what could potentially happen in assisted suicide were legalized.

Many of the disorders leading people to suicide are treatable, such as depression, alcoholism, and stress. If suicide were legal, it would give those suffering from this problems and easier out.

An attempt at suicide is often a challenge to see if anyone out there really cares. Indeed, seeking physician assistance in a suicide, rather than just acting to kill oneself, may well be a manifestation of precisely that challenge. If society creates a "right to suicide" and legalizes "physician-assisted suicide," the message perceived by a suicide attempter is not likely to be, "We respect your wishes," but rather, "we don't care if you live or die."

Reference:

Balch, Burke, Randall O'Bannon. "Why We Shouldn't Legalize Assisting Suicide."
National Right to Life. 15 March 2007. html>.

Natural vs. Unnatural Death

Life, though a precious gift, does ultimately end in death. It’s with common knowledge and acceptance that any living, breathing organism will die. Death can occur in two general forms, natural or unnatural.

A natural cause of death is loosely defined as an unpredictable or extreme act of nature caused without human intervention or agency (Natural, par.1). Deaths from old age or a sudden heart attack are examples of a natural death.

An unnatural cause of death is defined as death not describable as death by natural causes. This would include such events as homicide, suicide, or accident (Unnatural, par. 1).

It's important to define both natural and unnatural causes of death when discussing medical ethics because most people would want to die of natural causes. Unfortuantly being taken off life support would fall under an unnatural cause of death because it does involve human interference. This lays the foundation for my counter claim paper. I believe it will easier to write if I follow the above arguement.

Involvement of Nurses in Physician Assisted Dying

Death is often preceded by medical end-of-life decisions. Much of the research pertaining to this topic often focuses on the physician's role in assisted dying. There is not much information about the role of other health care workers, especially that of nurses.

A study performed by a group or doctors and nurses, centered around reporting the actual involvement of nurses in medical end-of-life decisions. The research investigated how often nurses were consulted by physicians in the decision making process preceding end-of-life decisions and how often nurses participate in administering lethal drugs in end-of-life decisions.

The study found that physicians consulted at least one nurse in 52% of end-of-life decisions cases occurring in institutions, compared with 21.4% of such cases at home. Nurses administered lethal drugs in 58.8% of euthanasia cases occurring in institutions and 17.2% at home. For cases in which life was ended without the patients request because the patient was too ill to do so, the percentages were 82.7% in institutions and 25.2% for cases occurring at home. In institutions, nurses mostly administered drugs without the attendance of a physician who had prescribed the drugs.

These findings were very surprising to me. I would have thought that nurses would have been more involved in euthanasia cases occurring at home, rather than the hospitals because nurses are often more involved in the home health care setting. The journal article is obviously much longer and detailed, the above facts and figures are just the gist of it.

Reference:

Bilsen, Johan, Robert Vander Stichele, Freddy Mortier, and Luc Deliens. "Involvement of Nurses in Physician-assisted Dying." Journal of Advanced Nursing. 47.6 (2004): 583-591.

Miracle in Medicine

As I was routinely signing into my Yahoo account, a very interesting (but short) news story caught my eye on Yahoo's homepage.

Christy Lilly spent the last seven years of her life in a persistent vegetative state after suffering from a heart attack and stroke. Her mother had been taking care of Ms. Lilly at her home in Colorado Springs, Colorado. Miraculously, Ms. Lilly awoke from her vegetative state for three days this week. She spoke to the local television station and was able to see her twelve year old daughter before slipping back into a vegetative state. Her neurologist is baffled and has no explanation for Ms. Lilly's brief awareness. It was reported that Ms. Lilly had awakened four other times for shorter moments in the past.

While I'm definitely going to research this particular topic a bit more, I thought it would bring an interesting twist to my previous blogs.

Reference:

"Woman in Vegetative State Awakes, Slips." Yahoo! News. 7 Mar. 2007. 8 Mar 2007.
.

An Important Case in the Field Medical Ethics

Never has the American public’s consciousness regarding life sustaining methods and the importance of advanced directives been so heightened as with the recent Terri Shiavo case. Terri Shiavo had suffered extensive brain damage in 1990 when she collapsed due to cardiac and respiratory failure possibly related to extensive dieting. She remained comatose for two and a half months and upon awakening regained a normal sleep wake cycle, yet did not respond to stimulus and was unaware of her environment. One year later, after many tests and attempts at rehabilitation she was diagnosed as being in a persistent vegetative state (PVS) (Wikipedia).

Terri, like other patients in PVS, exhibited many behaviors that could be construed as arising from partial consciousness. Grinding teeth, swallowing, smiling, shedding tears, grunting, moaning, and screaming without any external stimulus are common behaviors seen in patients in PVS (Persistent). Unable to acknowledge the need to eat or ability to be fed, Terri received a percutaneous endoscopic gastrostomy (PEG) feeding tube. The peg tube is surgically placed into the stomach through the abdominal wall, which allows the patient to be fed and hydrated. Terri was receiving the necessities of life, and could have essentially lived the average life span, yet with little quality or enjoyment.

References:
“Persistent Vegetative State.” Wikipedia, the Free Encyclopedia. 19 February 2007.
20 February 2007. http://en.wikipedia.org/wiki/Persistent_vegetative_state.
“Terri Schiavo.” Wikipedia, the Free Encyclopedia. 20 February 2007. 20 February 2007.
http://en.wikipedia.org/w/index.php?title=Terri_Schiavo&oldid=109672072.

Photo: Terri, before and after accident; obtained at: http://www.lldf.org/2_up_lg.jpg

Another Bloggers Insight

After many failed attempts at finding a blog that was even relatively close to my subject, I came across a blog posted by a gentlemen named, Derek Humphry. Mr. Humphry is the founder of ERGO- Euthanasia Research and Guidance Organization. He is a journalist that has published two bestselling books; one in the UK, and one in the US. "Final Exit" (a #1 selling book in the US) explains methods, approaches, and the means of voluntary euthanasia, physician-assisted suicide, and self-deliverance (rational suicide).

The particular entry I found interesting was dated January 19, 2006. Humphry defines different terms regarding euthanasia. He defines the following terms:
assisted suicide as helping a person to end his or her life by request to end suffering. Physician-assisted suicide is a medical doctor helping a patient to die by use of prescribing a lethal overdose of a drug. He describes the term euthanasia as a broad, generic term meaning "help with a good death." He defines a few other interesting terms.

Mr. Humphry's blog was interesting, yet incredibly biased. Which isn't surprising considering he wrote multiple books supporting euthanasia. I'm not so sure I'd reference his blog in my final paper, although one of his books may be interesting to check out. The particular blog that I referenced he lists as archival, from that blog is a link to his newly updated blog, which appears very insightful...http://blog.assistedsuicide.org/.

Reference:
Humphry, Derek. Euthanasia, Assisted Suicide, Right-to-Die, Final Exit, Hemlock Society
Founder Weblog. 25 February 2006. 1 March 2007.
<http://self-deliverance.blogspot.com/>.

Original picture obtained at:http://www.amazon.com/gp/reader/0385336535/ref=sib_dp_pt/103-6309303-4690248#reader-link

Nursing Dilemma

All too often people in the medical field find themselves dealing with the medical dilemma of the Full Code versus Do Not Resuscitate order. One article in particular that I came across details a nurses personal struggle when placed in that situation.

She had been taking care of an 80 year old man with bone cancer. He had gone into surgery to have his leg amputated, but during surgery he stopped breathing. The medical team was able to resuscitate him, but he had been without oxygen for too long and suffered anoxic brain damage. This left him confused and with limited mobility. (which is often the case when a patient is left without oxygen for a period of time) The patient, a once active man, was aware of his confusion and had become depressed. He often would state that he'd rather just die. His family thought the confusion was temporary and that he'd recover and be sent home. (again common in these situations) Unfortunately the patient declined and began to develop Cheyne-Stokes respirations. (often called the "death rattle" it's a common breathing pattern occurs when a patient is very close to dying) The nurse was in a tough situation because the doctors wanted the man to be resuscitated if he were to arrest to deter a law suit, but she felt it cruel to resuscitate a person in this condition.

The article goes on to explain that the main issue this nurse was faced with was whether or not to hold her obligation to the doctors or to the patient. In nursing school you are taught that you are there for your patients and that you must do whatever is in the patients best interest. Unfortunately the law keeps nurses from doing this at all times. The article continues to debate the sanctity-of-life principle (which states that all life is sacred and that to let life end is unethical) versus the quality-of-life principle (which focuses on quality of the patients life).

The article concludes that in order to make a decision that best benefits the patient, the medical team must consult the family and discuss what they believe the patient would want. Whether he would agree with the sanctity of life or quality of life and what he may feel is normative of a quality life.

Reference

Davis, Anne J. "To Make Live or Let Die." American Journal of Nursing. 1981. p 582. JSTOR. 13 February 2007.

Peer Review, Reviewed

February 8th, Thursday was one of our classes first peer review sessions. My group consisted of Danielle, Lindsay, Cody, and myself. I read Cody's paper first. He had written about Ben Franklin. I let him know that though he had very good information and facts, and a great introduction he needed to organize the paper Danielle's paper was about a man that had made it big in tobacco, yet sold out tobacco companies by exposing the health hazards of tobacco. Other then a few minor punctuation mistakes, the paper was very well written, well organized, informative and very close to being a final draft. Lindsay's paper about founding figures of Chinese acupuncture was very factual and interesting. I let her know to not only organize her ideas but to also give laymen definations of some of the terms she used. I pointed out a few minor spelling and punctuation errors that she warned us about before reading it. Lastly, the group reviewed my paper. I let them know ahead time that it was definatly a work in progress, and that I hadn't fully expanded on all my ideas. Cody asked me to explain my topic a bit more in detail, so I was sure to add that in my final paper. After reading my paper the some of the responses I got were to make the paper longer and to introduce Dr. Saunders full name in the beginning of the paper. These comments were taken into consideration when I wrote the final draft for this particular assignment. Overall peer review went well, and it was not only helpful to get my classmates opinion of my paper, but also to see how they wrote their papers.

Altered States of Consciousness

In many situations, the decision to take a patient off life support or stop life sustaining treatment co-insides with not only the patients expected quality of life, but also their level of consciousness. Altered states of consciousness often are the result of either a traumatic head injury or an underlying illness such as diabetes, infection, stroke, or brain tumor. There are a few different levels of state of consciousness.

A patient being described as in a stupor is generally unresponsive, yet they may arouse briefly to painful stimuli.

A patient in a vegetative state is unconscious and unaware of their surroundings. Sleep/wake cycles are noted and the patient may appear alert (eyes open), make noises, and have random movements, but remain unresponsive to stimuli and fail to follow any commands. A patient may come out of either a stupor or vegetative state within a few weeks.

A persistent vegetative state is defined as a patient who is in a vegetative state for greater then thirty days. The likelihood of recovery is poor and greatly depends on the severity of the cause brain damage and age. The younger a patient is the more likely they may recover.

Another altered state of consciousness is locked in syndrome. The patient is one hundred percent awake and aware but is unable to move due to complete paralysis.

Brain death results when there is no sign of brain function. The test generally run to show signs of brain death is an EEG (electroencephalograph).

Coma is a state of prolonged unconsciousness in which the brain functions at its lowest level. The patient is unable to be awakened and shows no purposeful response to physical or verbal stimuli. It differs from vegetative states in that a patient in a coma has no notable sleep/wake cycles. Recovery depends on severity of injury and illness and rarely lasts longer then two weeks.

It is difficult for doctors and medical professionals to give families a 100% prognosis in determining if their loved ones will recover. This often leads to families to have to make a difficult decision. Should they hold on hope for a full recovery if any recovery can be made, or should they let them go?

References

Mayo Clinic Staff. Coma. Mayo Clinic.com. 17 May 2006. <http://www.mayoclinic.com/health/coma/DS00724/DSECTION=1>. 11 February 2007.

Picture from:

http://www.cerebromente.org.br/n03/tecnologia/futuro.htm

Progress

Fortunatly I have picked a research topic that I am not only familar with, but also contains a great deal of information. I have yet to run into any snags in finding information about end of life ethics. Though I deal with with this topic on a day to day basis, like anything in this world, I don't know EVERYTHING about the subject, so I am definatly learning quite a bit along the way. The only major problem I'm dealing with at the moment is deciding how to narrow my reasearch down and focus on just a few key points. For example, do I want to focus on the legal aspects of death such as advanced directives, living wills, and all the grey areas inbetween, or should I focus more on topics such as euthanasia and hospice care? I realize I can write about all these subjects, and I'll touch on all of them a bit, but it may end up being a 14 page paper rather than the 8 we are assigned.

Another issue I am having is attempting to remain objective. Since I have been in situations through my work dealing with end of life topics I do tend to be a bit biased. Though my thoughts and feelings on the subject are entirely circumstantial. I've seen 16 year old comatose kids on ventilators recover and walk out of the hospital. (which is one of the most gratifying experiences in my life, just one of the many reasons being a nurse is great) I've also seen 16 year old kids with gun shot wounds remain paralyzed and comatose with machines running their lifeless bodies, because a parent will never give up hope. Nursing is a double edged sword. I want to save lives, but in some cases I want nothing more then for that person to be allowed to rest in true peace, not on machines.

I intend to continue my research in all subjects dealing with end of life ethics, and I'm sure when I sit down to write the final paper it will all come together.

Euthanasia

Euthanasia, or mercy killing, is the act of painlessly ending the lives of individuals who are suffering from an incurable disease or severe disability. It can be divided into two subgroups, passive and active euthanasia.

Passive euthanasia occurs when a person is allowed to die by withholding treatment, such as withdrawing a life-sustaining device. This could involve turning off a respirator or heart-lung machine. Technological advances in life-support devices raise the issue of quality of life. Should patients be kept alive in hopeless states? Passive euthanasia has become acceptable in cases of terminally ill patients. The argument that once equated this practice with suicide is rarely heard today. Although experts do not entirely agree on the precise boundaries of what treatment decisions should be made. For example, can a comatose patients life support be disconnected when the patient has left no written instructions, or does the family have the right to over rule a physicians order to continue life support? These questions have no clear cut answers.

The second form of euthanasia is active euthanasia. Active euthanasia occurs when death is deliberately induced, as when a lethal dose of a drug is administered to a patient. The most widely publicized cases of active euthanasia involve "assisted suicide." Jack Kevorkian, a Michigan physician, has assisted many terminally ill patients to end their lives. Kevorkian was convicted of second-degree murder and given a long prison sentence, after a controversial trial. Active euthanasia is a crime in most countries, and in all US states except Oregon. In 1994, Oregon passed the Death with Dignity Act. This act allows active euthanasia of individuals diagnosed with a terminal illness who are not expected to live more than six months.

While active euthanasia sounds acceptable in theory, the potential for abuse is substantial. If active euthanasia were to become acceptable, it's likely that depressed and suicidal individuals would use this method to legally kill themselves.

Reference:

Santrock, John. Life-Span Development: Tenth Edition. Ed. Emily Barrosse. New York: McGraw-Hill, 2006. 635-36.

Medical Pioneer

"You matter because you are you, and you matter to the last moment of your life." Words spoken from Dr. Cicely Saunders, the founder of hospice.

Dr. Saunders (June 22, 1918-July 14, 2005) began her university schooling in 1938 at Oxford University in England. Due to World War II, Saunders diverted her college career to become a nurse. (Nursing was an "on the job" learned trade back then). Through her work as a nurse, Saunders became a social worker (another career that didn't require a formal education back then).

In 1948 when she was working as a social worker she met a Polish man by the name David Tasma. Tasma was dying from inoperable cancer. Through her conversations and visits with Tasma, Saunders realized the need for a great change in the way dying patients were cared for. Because dying patients were considered beyond help, they were often left alone, much of the time in great physical, spiritual, psychological, and social pain. When Tasma passed away, he left 500 pounds to Cicley Saunders. With his gift Saunders realized her mission was to better the quality of life for dying patients. She would set out to establish better pain management and encourage holistic care.

Saunders was advised that if she was truly compelled to care for the terminally ill that she should become a doctor because no one would listen to a nurse. Following her friends advice she enrolled in medical school at the age of 33. She earned her medical degree in 1957 and became the first doctor to devote thier career to dying patients. Soon after recieving her doctorate she got right to work on devising better pain manangement methods. Through her work she learned to adminster morphine before a patient appeared in pain and to continue with timed doses as a way to "stay ahead of the pain." This method is used by most doctors today.

In 1967, Dr. Saunders opened the first hospice center in a suberb of London, St. Christopher's Hospice. This soon launched a worldwide movement to provide compassionate care for the dying. The first US hospice was opened in 1971 in Conneticut. There are currently 3,200 hospices helping 900,000 patients in the US alone.

Dr. Cicely Saunders died at St. Christopher's Hospice in 2005. Her legacy lives on throughout the thousands of hospices worldwide. Her life has impacted not only the medical world, but also thousands of patients and families. She is a medical pioneer and a compassionate hero.


Reference:

Field, Barbara. "Science Hero: Dame Cicely Saunders." Myhero.com. 23 June 2006. 1 February 2007. < http://www.myhero.com/myhero/hero.asp?hero=Cicely_Saunders_06>.

Original photo obtained at <http://www.cicelysaundersfoundation.org/>.

Something to think about

I enjoy having total control over my life. I decide what to have for lunch, what clothes to wear, and how I spend my money. I've gone so far as to controlling my death. Sounds scary to think about in my twenties, but the bottom line is, when it comes to that time, I have the control. I marched my twenty four year old body to the attorneys office and had him make me up some nice legally binding documents. I then distributed them to my parents and siblings. They accepted them with the sad, yet relieved knowledge that, if anything should happen there is a weight lifted off them because I told them what to do, in writing.

A living will is a written document detailing how you want to be treated in certain medical events, should you be unable to verbally express your wishes. It translates whether or not you want your life to be sustained in the event of a terminal illness or injury. This gives you the ability to make decisions in advance about the use of life sustaining treatments such as heart-lung machines, tube feedings, intravenous hydration, and other medical equipment that will either sustain or prolong life, yet not cure your condition. Depending on your state a living will can also be of use for medical conditions such as permanent unconsciousness or undetectable brain activity.

The living will is put into action when the decision to use life sustaining treatments may prolong your life for a limited period of time and not obtaining such treatments would result in death. This does not that you will be denied pain medications that would keep you comfortable.

A living will allows you to decide in depth how you want your life to be handled. It's an important document to consider having made.

American Bar Association. "Estate Planning Faq's; Topic V." 2005. 30 January 2007. <http://www.abanet.org/rppt/public/home.html>.

My Job

I have broken a 92 year old woman's ribs. It's very commen to break a patients ribs while performing basic life support. Unfortunatly old women's bones tend to break more easily. I'll never forget the cracking sound I not only heard but felt as I pumped on her fragile chest attempting to revive her heart. Needless to say our efforts were fruitless, she passed away, like many old, sick patients do. The difference is she ended her life with a me on top of her breaking her bones, tubes shoved down her throat, shock pads stuck to her chest, and a mob of nurses and doctors shouting and pushing drugs into her dry veins. It sounds horrifying, and it is, but it's one of the standards of my job. I am paid to save lives. It's not always a good feeling to revive a human life when I know that the quality of that life is poor, but there is a set of rules, laws and regulations that requires me to attempt all means possible to save a life. Unless of course that person has made their end of life wishes known to their family, lawyer, and doctors. That's where code status comes in to play. DNR-do not resusitate, or Full Code-perform everything that can be done. Sounds clear cut, but unfortunatly, like all laws their are loophools. I guess that's what my research will be based on, all the unclear, grey area, ethical issues I deal with at work.