Thursday, October 7, 2010

Hospice Nursing: Embracing the End of Life

Those who are pro-life espouse the mantra of protecting life from conception to natural death. Indeed, it is science that is on our side. To those who are pro-choice there is a mantra that bodily autonomy, freedom of privacy, and the rights to make decisions are more important than the right to life.

I am going to shortly describe how the end of life connects with the pro-life cause and relate it to my nursing career.

Do those who are dying have a right to life?
Yes. Those with a terminal diagnosis have a right to live their lives in the way that they choose. Those who are dying have a right to pain relief, to be comfortable, to be at home, to be with their loved ones, and to pass on from this life in the way that is most respectful to them. We all have a right to life; indeed, we can all choose how to be treated in end-of-life care that respects our lives.

Do those who are dying have a right to die?
No. Those with a terminal diagnosis have a right to determine in what ways they will pass from this life to the next but they do not have the right to kill themselves or to obtain aide in doing so. The rights of those who are dying are exemplified by their life itself and the quality of their lives. We cannot take one without the other.

Some claim that it is torturous to deny the right to die to those that want it.
Some have this contention. Those that have terminal diagnoses often experience pain, discomfort, loneliness, ambivalence, uncertainty about the afterlife, regret about some things done during their lives, depression, and other troublesome experiences. However, actively killing the actively dying does nothing to address these issues. It ends these issues but does not deal with them.

How can those issues be dealt with?
Pain: The ability to control pain has seen many advances over the years. It is possible to control pain for practically all terminal patients. Indeed, controlling pain is a huge priority for caregivers and the dying patient. It is up to the patient to determine how much pain relief is necessary while weighing the side effects (stupor, fatigue, constipation, etc). Death as a result from pain medication is a real possibility. However, if pain management has been done properly then death caused by pain medication is not the intent but rather a side effect. For those who are dying, death is imminent. Thus, controlling pain is vital and may hasten death as a side effect. This is not tremendously common and is also not the intention of the pain management regimen and is thus not considered in the realm of euthanasia. It is being respectful of the patient's wishes to be pain free during the dying process and nothing more.

Discomfort: Those who care for the dying are able to help a patient with comfort whether they be family, friends, caregivers, nurses, or doctors. Hospice allows a patient to experience least discomfort as can be possible. Indeed it is best for those who are dying to experience their last days in their own home in the ways that they desire. These measures reduce discomfort. Other causes of discomfort such as nausea, vomiting, diarrhea, constipation, and other problems can also be managed with medications and other therapies.

Loneliness: Those who visit the dying patient include a wide array of individuals such as nurses, pastors, and volunteers. These resources are vital to help curve the feeling of loneliness. The worst fear many people have is of dying alone. Hospice care and loving families help prevent this from happening. Indeed, visitors are vitally important for those who have a terminal diagnosis.

Ambivalence: Hospice care provides those who are dying and their families with answers regarding the process of death, dying, and the care that they will receive. It helps all of those involved to have an understanding; this helps in reducing fear, pain, discomfort, and many other unfavorable things.

Uncertainty About the Afterlife: Having a Hospice team that is willing to speak with patients regarding the life after death is very important. One does not need to share the same faith with each other to know that most people worry about what will happen to them after dying. Some may not care, many others will. This is also why chaplain services are readily available to those on Hospice. When someone has comfort with what will happen to them following their death then it can help calm and comfort.

Depression: A broad support system oftentimes helps those who are depressed. Hospice provides that to a great deal. However, this does not always help fight against depression. Clinical depression can be treated with medications while other depression can abetted a little bit at a time by a support group. Oftentimes volunteers can provide companionship that busy nurses and other workers cannot give as much as they would like. Many Hospice organizations provide volunteers and other services to help brighten the last days of patients with terminal diagnoses.

How does hospice relate to the pro-life cause?
Hospice should not provided a means to end a persons life. It is about increasing the quality of the time a person has left to live. Allow me to simply compare and contrast:

Euthanasia is a quick end to suffering; hospice deals with the problems to allow comfort and dignity.
Abortion is a quick end to an unwanted pregnancy; choosing life deals with the unwanted pregnancy to allow a newly created human being to live.

Just like there are many issues that surround end-of-life care that can be managed, there are many problems with an unwanted pregnancy that must also be managed.

I have been a hospice nurse for seven months. It can be very stressful, but it can also be very enlightening. I have been a small part of the care to help so many patients pass away with comfort and dignity. I have such awesome coworkers who have also helped these patients in their own special way. I am so thankful to work with such a wonderful group of people who have such compassion for their patients.

Indeed, giving life is the most important aspect of hospice nursing. This is the reason why I continue to work hospice. Respect life! Give it dignity! Give it what it rightfully deserves! Embrace life from conception until natural death.