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PBH2004 Health Law And Ethics Questions Address The Following Questions On The Topic End Of Life Decision Making. 1. Why is the topic the area you have chosen a significant health issue ? 2. What are some of the ethical issues in this area? 3. What are some of the legal issues in this area? 4. What is happening in Victoria/ Australia this year in relation to your chosen issue? 5. Do you agree with the current approach? If so, why? If not, Why? Agree with the legalisation. Answers Introduction  End of life decision making in simple words can be understood as the process through which the healthcare experts, patients as well as their families undergo at the time of treatment of life threatening illness (Thelen, 2018). There are a number of forms available during this decision- making process. The first is the advance directives in which the patient’s are given opportunity to showcase their preference in writing before the occurrence of the critical illness. It has been proved that advance directives have minimal impact on the actual care that is being received by the patient at the time of end of life (Medline Plus, 2018). Another such decision is related to resuscitative efforts. This is related to DNR orders that are Do-Not-Resuscitate which may vary from content to content depending upon the patient’s request that is to use no resuscitative efforts or to use limited efforts at the time of cardiac arrest (Weiss & Hite, 2000). The third type of end of life decision is related to the withholding or withdrawing of the life sustaining therapies and equipments being used during the end of life. These include antibiotic therapy dialysis, mechanical ventilation administration of fluids nutritional feeding, etc. (Curtis, et al., 2002). Many experts have shown their interest towards improving the decision -making process near the end of life. It has been seen that many times conflict arises when the meaningful survival of patients is not possible but, the expert’s main aim is to preserve life and take decisions that benefits the patients. This has taken the shape of ethical decisions in the field of health care. This is so because the current law and policies have made the patients self determination as priority while taking decisions related to end of life. The new laws have given the power to patients to refuse the medical treatment (Rosenfeld, Wenger, & Kagawa-Singer, 2000). 1. End of life decision making is a very important and crucial topic that is related to the ethics of health care. This issue is important as it requires critical scrutiny as it has been seen that very rarely health care researches have focused or questioned the bioethics practice that is based on the power of autonomy. Many of the researches have just focused over the idealized discourse of the patients and their decision towards the embracement of their dying condition (Drought & Koenig, 2002). Some of the issues revolving around the end of life decision include autonomous decision -making. This is an issue as, at the time of decision- making many complex thoughts arise which poses a serious challenge in front of the patient as well as their family members at the time of end of life. (Emanuel & Scandrett, 2010). Conflict between the healthcare providers and patients is also an important issue that is seen in such cases. This usually arises when the patient or their families and the healthcare providers are not able to adopt a mutual decision (Winzelberg, Hanson, & Tulsky, 2005). Another issue related to this is that when the family is supposed to take decisions as surrogate or proxy, then they tend to take emotional decisions as they are emotionally attached to the patient. Also, there are chances that their decision may be influenced on the basis of their emotional condition or financial pressure and hence, such decision taken may not be in favour of the patient’s benefit. Hence, this may give rise to legal and ethical issues during the end of life decision (Monagle & Thomasma, 2004). Another major issue related to this is that because of the technological advancements like life support systems etc. the unaffordable cost of healthcare is on an increase and hence, this is giving rise to inequitable healthcare services (Hopkins, 2010). Hence, it can be said that many ethical issues are connected to this issue and hence, this is the major reason for selecting this issue. Many times it has been seen that the healthcare providers has to consider patient’s perspective and has to go against their ethics which asks them to take decisions that are beneficial to the patient. Hence, this issue is challenged by many medical experts and many areas still need to be explored over this topic (Karnik & Kanekar, 2016). 2. End of life decision making is seen as an ethical problem in the clinical practice by the healthcare providers. This is so because the physicians have to write the orders related to the end of life decisions and so they feel heavy burden of responsibility while doing so (Nordgren & Olsson, 2004). This is so because during such situations, they feel like who are they to take such decisions. It has also been seen that apart from physicians and families conflict arises even between nurses and physicians. This is so because they find themselves in dilemma when the physician either stops the treatment too soon or continue the treatment for too long when it is not required (Tripathy, Routray, & Mishra, 2017). This results in moral distress as nurses start to believe that they are contributing in the patient’s suffering and is working against the benefit of the patient (Oberle & Hughes, 2001). Hence, this is a serious issue and therefore requires many ethical perspectives at the time of dealing with such issue. It has been seen that healthcare providers find them in difficulty when it comes to equitable and distributive justice in the cases of such patients where expensive treatment is required. Also, healthcare providers find them in a fuss when they do not have the required resources to offer to the patient at the time of end of life decision making. Also apart from this, it has been seen that the physicians find it very difficult to make the families of patient understand about the seriousness of the situation and to agree them on taking certain decisions that is beneficial for the patient (Thorns, 2018). The main ethical dilemma in case of physicians is experienced when the families are not able to come to a conclusion and the main decision is required to be taken by the healthcare providers. At such situations, the physicians are not able to decide the difference between what is ethically correct and what should actually be done (Matzo, Sherman, Nelson-Marten, Rhome, & Grant, 2004). The right of the patients to refuse treatment is also seen as an ethical issue in front of the physicians. This is so because, the physicians want to take care of the patient till the end of the last breathes of the patient, but if the patient denies receiving treatment, then it stands as an ethical dilemma in front of the doctors and nurses (Kyba, 2002). 3. Any person who is suffering from any sort of pain and not just dying deserves to get treatment and get relief from pain (NAP, 2018). The physicians and nurses have both the legal as well as ethical right to protect the life of a person. But, it has been seen that many laws are being adopted in several cou-ntries that are legalizing that the end of life decision should be left on the patient and the final decisions will be on the basis of the patient’s decisions. It has been seen that these legalities stand as issues in front of the physicians when they want to help the patient but, the ultimate decision is of the patient (Rahman, 2017). Some of the major legal issues that are faced during the end of life decision are related to the advance directives. That is, if the person has already developed his or her advance directive before losing his or her capacity, then it is fine. But, if the patient has not developed advance directive, then this poses a serious legal issue. This is so because in such cases the next person to take decision is the family members of the patient. This may pose serious issue as the person will decide on the basis of what he or she believes and what is in their best interest and may not consider the interest of the patient. So in such cases, the patient may not get what he or she deserves (Queensland University of Technology, 2018). 4. Euthanasia is a form of end of life decision. Euthanasia in simple words can be understood as an intentional act of a person towards ending the life of another person in order to relive that person from suffering. Such acts are sometimes considered as assisted dying as it is seen as one person that is the doctor or the family or friend of the patient assist the patient to intentionally kill themselves. These acts are illegal in Australian States and Territories. In Australia, the person caught practicing Euthanasia may be charged with murder or manslaughter or as they term it as assisting suicide. But, this scenario is going to be changed in Victoria with effect from 19th June 2019. In Victoria, the assisted dying that is Euthanasia is going to become legal under certain limited circumstances. In the year 2015, the Legislative Council agreed to pass the motion related to the discussion of need for laws in Victoria that will give the rights to patients to take end of life decisions. A committee was established in 2016 to discuss over this and 49 recommendations were made including legalizing assisted dying in Victoria. And on the basis of the final result came out in the form of Voluntary Assisted Dying Bill 2017, which legalized the use of euthanasia under certain limited conditions (Parliament of Victoria, 2018). One of the prominent neurosurgeons Brian Owler who has also been the head of the Australian Medical Association is joining hands with the former chief minister of Northern Territory that is Mr. Marshall Perron to support the private member’s bill that is related to the repealing of the ban on Australian States related to the legalization of euthanasia. Hence, it can be said that many experts and veteran politicians of the country are in the favour of euthanasia and is taking all the possible efforts to legalize euthanasia in every state of Australia (Murphy, 2018). 5. I believe that the current approach adopted by Victoria / Australia towards end of life decisions is correct. This is so because every person has all the possible rights to take decisions related to his or her life. If we consider about the human rights, then right to die is also a human right which should be given to citizens. Also, death is a private matter and if it is not causing any harm or damage to any other person or state then there is no right to interfere in the patient’s decision. Another important fact is that it is possible to regulate the end of life decisions like for example, euthanasia in case of Victoria is regulated by making it legal under certain conditions. Hence, this will help in keeping a check over any evil intentions or any wrong doing of the patient’s family members or friends. It is the right of every person to relief him or her from pain and misery if they want to and no one should interfere in this. Hence, I believe that this legislation of the Victorian Parliament is right and all the other states should support this decision of the government. Conclusion In the end it can be concluded that if the end of life decision is regulated properly, then there is no harm in giving the right to decide within the hands of patients and their family members. Though, many ethical and legal issues are related to this topic but, with the help of proper regulation these issues can be overcome. Also, it is important that the physicians and the patients and their family members should take efforts to reach to a mutual agreement so that the physicians do not find themselves in ethical dilemma during the end of life decisions.   Bibliography Curtis, J. R., Engelberg, R. A., Wenrich, M. D., Nielsen, E. L., Shannon, S. E., Treece, P. D., . . . Rubenfeld, G. D. (2002). Studying communication about end-of-life care during the ICU family conference: development of a framework. Journal of Crtical Care, 17(3), 147-160. Drought, T. S., & Koenig, B. A. (2002). “Choice” in End-of-Life Decision Making: Researching Fact or Fiction? The Gerontologist, 42(3), 114–128. Emanuel, L., & Scandrett, K. G. (2010). Decisions at the end of life: Have we come of age? BMC Medicine. Hopkins, J. (2010). Reasoning Through The Rationing Of End-Of-Life Care. Retrieved from Karnik, S., & Kanekar, A. (2016). Ethical Issues Surrounding End-of-Life Care: A Narrative Review. Healthcare, 4(2). Kyba, F. C. (2002). Legal and ethical issues in end-of-life care. Critical Care Nursing Clinics of North America, 14(2), 141-55. Matzo, M. L., Sherman, D. W., Nelson-Marten, P., Rhome, A., & Grant, M. (2004). Ethical and Legal Issues in End-of-Life Care: Content of the End-of-Life Nursing Education Consortium Curriculum and Teaching Strategies. Journal for Nurses in Staff Development (JNSD), 20(2), 59-66. Medline Plus. (2018). Advance Directives. Retrieved from Monagle, J. F., & Thomasma, D. C. (2004). Health Care Ethics: Critical Issues for the 21st Century. Jones & Bartlett Learning. Murphy, K. (2018, july 25). New push to overturn Australia’s Howard-era euthanasia laws. Retrieved from NAP. (2018). 7 Legal Issues. Retrieved from Nordgren, L., & Olsson, H. (2004). Palliative care in a coronary care unit: a qualitative study of physicians’ and nurses’ perceptions. Journal of Clinical Nursing. Oberle, K., & Hughes, D. (2001). Doctors’ and nurses’ perceptions of ethical problems in end-of-life decisions. Journal of Advance Nursing, 33(6), 707-15. Parliament of Victoria. (2018). Voluntary Assisted Dying Bill 2017. Retrieved from Queensland University of Technology. (2018). Legal Overview. Retrieved from Rahman, D. S. (2017). Legal and ethical issues around end of life care in dementia – lecture . Retrieved from Rosenfeld, K. E., Wenger, N. S., & Kagawa-Singer, M. (2000). Intensive Care. Retrieved from Thelen, M. (2018). End-of-Life Decision Making in Intensive Care. Retrieved from Thorns, A. (2018). Ethical and legal issues in end-of-life care. Retrieved from Tripathy, S., Routray, P. K., & Mishra, J. C. (2017). Intensive Care Nurses’ Attitude on Palliative and End of Life Care. Indian Journal of Critical Care Medicine, 21(10), 655–659. Weiss, G. L., & Hite, C. A. (2000). The do-not-resuscitate decision: the context, process and consequences of DNR orders. Death Studies, 24(4), 307–323. Winzelberg, G. S., Hanson, L. C., & Tulsky, J. A. (2005). Beyond autonomy: Diversifying end-of-life decision-making approaches to serve patients and families. Journal of the American Geriatrics Society, 53(6), 1046-1050.

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