New Ways to View Death and Aging?

Through the last view lectures, we learned many aspects of end of life care, such as being in the intensive care unit, in nursing homes, and in hospice care. The main overall view we can get from these aspects is we need to change our view of death, and make sure the patient gets what they want or deserve. Maybe they would not prefer treatment and rather die in the hands of their loved ones or near them, therefore sending them not to ICUs but rather to hospice facilities or just the comfort of home. Maybe the old would rather be living their own lives, like those in the neighborhood for the elderly, instead of being monitored for their own health. This would lead us to believe that we need a change in how we view death and aging.

Whereas death may be viewed as a terrible thing and prevented, we should treat is as an inevitable situation and have the patient be the one in control when it is their own death. Death should not be a taboo subject, but again it should be embraced when the time has come. In this state, the most optimal thing to do would be allowing the patient the most comfort they can afford. Aging should be viewed in a similar fashion. People who are aging should not be viewed as feeble or fragile and have to be looked for (unless they have to due to a condition such as Alzheimer’s) but rather looked as capable individuals who have their own wants or needs. Rather then confine them because they are close to death, allow them to do whatever they want because they almost have no more life to live. There is a shift toward this view, but a lot more thought would be needed to fully push the view toward the main picture and have it embraced by everyone. At this point, will we be able to actually conquer death: when we accept it and gain a sense of comfort from it.

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How can we ensure patient/consumerist power in end-of-life care?

Within the article titled “Watching Brian die: The Rhetoric and Reality of Informed Consent, the aggressive mindset of the ICU doctors, which placed little importance on palliative care, undermined the legal authority of Lisa, Brian’s wife and thus next of kin, to make decisions regarding his treatment. The clash of opinions between Brian’s family and Lisa’s family about Brian’s desire to live further accentuated that fact. It is even suggested that due to Lisa’s lack of knowledge regarding Brian’s desire for aggressive treatment, she was less assertive in establishing a line of communication with the ICU doctors, allowing for Brian’s father Jack to take the reins. Had Brian and his family previously held discussions before the accident about their individual beliefs regarding their own end-of-life care, could Lisa have retained her power as legal authority, prevented the usurpation of such position by the ICU surgeons, and avoided familial strife as a result? How early should we as individuals begin having those kind of discussions with our families? If no changes would have resulted from such discussions, how can we increase or ensure patient bargaining power in medical care, specifically in ICUs?

How much treatment do ICU physicians really provide?

In Zussman’s article “The patient in the intensive care unit, Zussman discusses how medical providers in the intensive care unit focus solely on physiology alone rather than looking at the external psychological or acute problems the patient may have. It makes sense to a certain extent that this would be the main focus of treatment since the medical crisis at hand usually centers on the physiological the patient has endured. However, what stood out to me after reading this article was the account of the treatment of a patient who tried to commit suicide. This eighteen-year-old patient had overdosed on drugs and was taken to the ICU, where the physicians focused solely on his liver damage. They were not at all concerned about his psychological damage however, or the underlying problems that had caused the liver damage in the first place. In cases like this, the patient’s underlying problem may not be as immediately dangerous as their physiological problem but is the cause of their physiological problem and may be even more dangerous in the long run. Is this underlying problem addressed after they leave the ICU? Do the physicians in the ICU at least acknowledge the underlying problem to the extent that they will refer the patient to a psychologist or another physician that focuses more on treating said underlying problem? Or are the ICU physicians so focused on getting the patient out of the hospital with minimal physiological damage that they simply feel as if this is not their responsibility? How much treatment is really being provided if the underlying problems are not being addressed at all and may cause the patient to end up in the ICU again with a worse medical crisis due to this underlying problem?

Are we going overboard with standardized care, especially at the end of life?

When it comes to surgery, standardized procedures are of utmost importance. For instance, A surgeon is trained to cut into a person with accuracy and precision. He or she better follow every step to the T as they were taught to avoid forbidden mistakes. Between different hospitals, there should be standardized treatments and care to ensure that every person is accessible to top-notch services, no matter the geographical location.

However, the world can be a little bit obsessed with standardization. As students, we have to take standardized exams to qualify for college and beyond. Neuropsychologists administer various standardized tests to their patients to measure cognitive abilities. And, according to “The Patient in the Intensive Care Unit,” a resident proclaimed, “The numbers, I feel, they are more reliable” (Zussman 541).

As a student, I can only relate to being defined by objective data just as the patients in the ICU are labeled with laboratory values when I am referred to by my BU ID. How might being a student identified as an ID number be different from being a patient in the ICU? A resident proclaims, “‘They [Patients] have names…but we speak of the patient in that bed with this problem.’ Because a lot of people are intubated, they can’t talk. And so you’ve got to just deal with them not as a person but as a problem, a set of numbers and dynamics. We’re not dealing with a walking, talking person” (Zussman 545). Similarly, a college advisor who is interested in learning more about a student can quickly glance at his or her BU ID and GPA to make a few judgments about the student. In the ICU, Zussman states that even when patients’ histories are known, they become secondary data to the objective measures obtained by laboratory tests.

With that said, I wonder if medical professionals are going overboard with standardized care, especially at the end of life by basing their decisions and assumptions about the patient simply on objective data and laboratory values? Throughout our lives, are we all dehumanized as students, as patients, as human beings? As neuropsychologists are well aware, there are certain behavioral problems that simply CANNOT be measured by standardized testing.

 

Should patients be released from ICUs to die at home?

    In class, we learned today about end of life care and the procedures that go into that care. Recently in the news, I’ve also learned that physician assisted suicide is becoming gradually more accepted, giving patients the right to end their pain. Although this is a large step from the indifferent end of life care and they do get to spend their last moments with their family, it is still in the hospital: a generally more morbid and depressive setting. The first thing we learned this lecture is how many patients and people in general would prefer to die at home. Shouldn’t we grant them that very right before they die?
    Instead of still having the patient hooked up until they decide they would like to die, maybe we should use tools such as fMRIs or EEGs to ask the patient if they would want to go home and live the end of their life there. By living the end of their life in the hospital setting, although they do decide to die, they end their life in the worst possible place, with sick and dying people around them. Releasing them from that setting, ultimately would grant them a little bit of happiness before they are let go with their family next to them. Death shouldn’t be as stigmatized as it is, and it only is this stigmatized because we related illness and hospitalization to death, when inevitable death should be looked as the moving on with life. It should be looked as spending time with family in a familiar setting when you move on instead of with grief and pain. So ultimately my question becomes should we release patients from hospitals and ICUs so they can die at home?