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Managing care at the end of life
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Predicting when someone might die is difficult and is often poorly judged. Families will often ask health professionals to give them an indication of when their relative might die. It is important not to guess or to be persuaded into giving an answer that can be incorrect. Experienced health professionals who are competent in recognising signs and symptoms of active dying, might be able to give indications of hours, days or weeks (Mitchell and Elbourne, 2020). It would be appropriate to explain the unpredictability of the situation and support the family with focusing on the present and how they could assist in supporting the person’s comfort and dignity (Garbutt 2018). The common signs and symptoms that signify when someone is actively dying include:
The end of life – people's experiences
Published in Catherine Proot, Michael Yorke, Challenges and Choices for Patient, Carer and Professional at the End of Life, 2021
Catherine Proot, Michael Yorke
A younger and healthier person who has suffered a traumatic experience can, with some effect, manage the physical and psychological assaults which cause them fears. The memory which is committed to the deep subconscious is held successfully by iron gates and heavy padlocks. The conscious mind can spend a lifetime keeping that memory locked up and ‘safe’. As people get weaker, their defences against such assaults dwindle, and therefore the gates are forced open, and something of the force of the terrifying memory returns, raising great anxiety in the frailer person. The old trauma clearly still has its teeth. As the person begins the process of dying, their peace is disturbed, and the fears and stresses return. Such was the experience of Elaine. A woman in her forties, Elaine, seemed unable to die in spite of multiple organ failure. A psychologist noted the facts of her life and realised that she felt strongly that she had had a negative influence on her family and especially against her husband moving to higher office in his work. Elaine suffered profound subconscious guilt about this. The impact came as an addition to her fatal illness. The psychologist, after much thought and using his considerable experience, closed her subconscious negativity and she died peacefully four hours later.
Management of Conditions and Symptoms
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Amy J. Litterini, Christopher M. Wilson
Questions often arise from family members regarding how long their loved one has to live. The interdisciplinary team may have discussed this in conference or in consultation with one another. This timing is notoriously difficult to predict, so often a range is offered to help guide the preparation of those observing this process. Timeframes such as days-to-weeks, or hours-to-days can provide some surety in the uncertainty of the dying process, and open a conversation about what is occurring. End-of-life caregivers are aware that the life process can go on longer than expected, or end suddenly. It is good to be aware and help the family to understand that the dying will happen in its own time. In some instances, the person will hold on until a certain loved one arrives; in others, the person seems to wait until an often fatigued loved one leaves momentarily, and then slip away. Whatever happens, it is as it was to be, after the best efforts of all involved.
Donors and Organs at the Borders of Vitality and Public Trust: Why DCD Donors Must Be Dead and Not Dying
Published in The American Journal of Bioethics, 2023
In their view, after the “no-touch” period during cDCD, the removal of a donor’s abdominal organs, i.e., kidneys and liver, does not violate the DDR. Assuming that the “no-touch” period rules out physiological auto-resuscitation of circulation and respiration, and the patient or surrogate has enacted a do-not-resuscitate order that prohibits clinicians from trying to reverse the physiology, they argue that the donor’s physiological state is “no longer consistent with life” and thus the abdominal organs are no longer “necessary for life.” The authors are ambiguous, perhaps purposefully, as to whether the donor is incontrovertibly dead or simply dying, after the no-touch period. (If the condition of the donor after the no-touch period is, as they say, “inconsistent with life,” doesn’t this mean that the donor is dead?) They are, however, resolute that, if the donors will inevitably die with or without the removal of the abdominal organs, the organs are not “vital” and their procurement therefore does not cause the death of the donor. Moreover, the donor can continue to “live” for some short time without these organs. If the donor is dying, they argue that it is the continued cessation of circulation and respiration that causes death. What counts as a “vital” organ is thus contextualized, and the ethical obligations of the DDR that organ procurement not cause the donor’s death remain fulfilled.
Some Problems with the ‘It Has Been Decided That You Will Die and Are No Longer in Need of Your Organs Donor Rule’
Published in The American Journal of Bioethics, 2023
There are also persons who are “on an inevitable trajectory toward death” who are not terminally ill, but who are on this trajectory either because they have chosen it themselves e.g. they have already scheduled euthanasia or assisted suicide, or because others have chosen it for them e.g. their execution has already been scheduled after final appeal of their death sentence1. In both cases Nielsen Busch and Mjaaland’s argument lead to the conclusion that such persons will have organs that are “no longer necessary for life” some days before the already determined end of their life, and that a fortiori explanting those organs for transplantation now is therefore not a contravention of the DDR, and presumably all things considered acceptable as long as proper consent or authorization is obtained. In order to avoid this implication of their argument the authors might argue that the persons in question are not dying or in a dying process. The only way to make out that argument is if dying or being in a dying process is a purely biological phenomenon. That, however is clearly not the case for human beings. We die as biological and social entities, and for humans dying is as much a social and existential process as a biological process. For someone seeking assisted suicide at Dignitas in Switzerland boarding the plane to Zürich is part of the dying process, just as being “fortified by the Rites of Holy Mother Church,” a standard phrase in many English public death notices is part of the dying process of many Catholics.
Ars Moriendi: An Overview of Approaches to the Art of Dying, Grief and Loss for Nurses Working in Mental Health
Published in Issues in Mental Health Nursing, 2023
Meagan G. A. Dickerson, Darren Conlon, Toby Raeburn
Nurses working in mental health are best placed to lead a contemporary discussion on how to provide improved emotional support and holistic end of life care, because at the modern deathbed as with the medieval, “the person in charge issues precepts: the nurse unsqueamishly gets on with the business of care” (Riddy, 2003, p. 224). This paper will equip nurses working in mental health (and other relevant clinicians) with an understanding of medieval and early modern ideas about what constitutes a good death. Consequently, providing them with the knowledge to develop strategies to assist patients and their significant others to cope with fear and grief related to the process of dying. This knowledge will also assist nurses working in mental health to reflect on how they can better support their patients to experience a ‘good’ death.