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Patient and family requests for hastened.
| Content Provider | CiteSeerX |
|---|---|
| Author | Abrahm, Janet L. |
| Abstract | Patient and family requests for hastened death, upsetting as they are to the treating team, are usually a way for patients and their families to express their need for an increase in the intensity of communica-tion, improved symptom control, or acknowledgment of an existential or spiritual crisis. Rarely do they represent the need for patients to control the time, place, and manner of their death. Using a hypothetical case study, this paper reviews the unspoken concerns underlying these requests; characteristics of patients who request a hastened death, and when and why they make the request; the Oregon Death with Dignity Act and its implementation since its passage in 1997; the effect these requests have on clinicians, their com-mon reactions, and suggestions for self-care after such requests; techniques for responding to the requests and keeping the dialogue open with the patient and family; and the legal and ethical options available to clinicians outside of Oregon. The Challenge Dr. V, a 55-year-old sociology professor living in Vermont, has had multiple myeloma for 6 years. She has been mar-ried for 30 years, with 2 children, aged 25 and 20. Dr. V had an initial remission, relapsed after transplant, and was un-responsive to investigational agents. She had a terrifying delirium from high-dose corticosteroids. Four weeks ago, she was admitted for sepsis, dehydration, and oliguric re-nal failure, and has been on thrice weekly dialysis for 3 weeks. She and her family have learned to work out dis-agreements about therapy with the help of their hematol-ogy team, therapists, and their rabbi. This morning, when you meet with her and her family, she tells you she wants to discontinue dialysis. She recounts her amazement at the journey her family has been on to-gether, their growth in understanding and love for each other, and she assures you they are at peace. She is not depressed, but she knows that after she stops dialysis, she will only deteriorate. She does not want to “watch herself die. ” Her family is tearful, but says that they are all in agree-ment with whatever she wants. She is hoping you can end her life as quickly as possible. What is she really asking for? What underlies the re-quest? How do you feel about her request? What are your legal and ethical options? What do you want to do? |
| File Format | |
| Access Restriction | Open |
| Subject Keyword | Family Request Ethical Option Oregon Death Hypothetical Case Study Challenge Dr Unspoken Concern Spiritual Crisis Hematol-ogy Team Thrice Weekly Dialysis Dignity Act Multiple Myeloma Improved Symptom Control Oliguric Re-nal Failure 55-year-old Sociology Professor Living Com-mon Reaction Hastened Death Treating Team Investigational Agent High-dose Corticosteroid Initial Remission |
| Content Type | Text |
| Resource Type | Article |
