Health care ethics: End of Life / Care of the Dying

End of Life / Care of the Dying


End of life is simply a synonym to the word death.  It refers to the point of life whereby all the vital organs of the human body cease to function. There is an assumption that organs such as the lung, brain and heart cease to function more or less at the same to cause end of life. This is the definition of end of life before invention of life support machine.

Technological advances led to invention of a life support a machine which makes it very difficult to determine whether a patient has died or not. For instance, it is possible to restart the lung and heart of accident victim using cardiopulmonary resuscitation technologies and treatments. In the past end of life could be pronounced in case the brain of a patient ceases to function but that is not the case in the contemporary society. Currently there is a life supporting machine situated in the intensive care units which keeps a patient with a dead brain alive provided that his or her lung and heart are still functional. Due to these technological advancements a clear line has been drawn between life and death. Medical practitioners find it challenging to declare a given patient dead without risking legal interventions (Jonsen, Siegler & Winslade, 2015).

In the year 1981, UDDA was enacted to define end of life. With respect to this act, end of life to an individual occurs in case his or brain ceases to function permanently. The act was based on the fact that it is impossible for an individual with a non-functional brain to continue working. Brain cells are very complicated and delicate; they need supply of oxygen to function properly. However, when damaged they are irreparable. Medical practitioners can declare end of life of a patient in case there is neither flow of blood to the brain nor electrical activity.

Ethical Dilemma

What are some of the ethical issues faced by physicians when administering care to patients who are terminally or seriously? What are the pros and cons of these ethical issues?

Symptoms in End of Life Patients

Depression, pain and difficulty in breathing are the commonly known symptoms experienced by patients who near end life. Out of four patients near end of life, there is one suffering from depression. Approximately 75 percent of patients near end of life exhibit difficulty in breathing while the remaining percentage experience substantial pain.

There are two methods which are used to manage these symptoms in end of life patients. They include drug treatment and non-drug treatment.

Treatment of End of Life Symptom using drugs

This is the common symptoms management method used in most health care centers. Health care professional normally use this method because it is scientifically proven and provide desired results within the shortest time possible. However, studies have also proven that most of the drugs used in symptoms treatment negatively affect the patients. Some of the side effects of such drugs include; unconsciousness, delirium, nausea, vomiting, drowsiness and diarrhea. Patients and their family members have to make decision on whether to adopt drug treatment or not bearing in mind that it increases the chance of prolonging patient’s life (Grace, 2013).

Marijuana is a drug that is normally recommended for patients nearing end of life because of its commendable qualities. It does not only relieve patients from pain but also improve their appetite and reduce nausea. Consumption or possession of this drug is prohibited by several countries across the world. This is due to its side effects when abused. Marijuana is highly addictive and put the risks of end of life patients to addiction in case they recover from their illness and experienced prolonged life (Jonsen, Siegler & Winslade, 2015).

Treatment of Symptoms without drugs

Aromatherapy, massage therapy and hypnosis are some of the non-drug treatments to symptoms in End of life patients. It is the responsibility of the patients or their family members to decide whether non-drug treatment can be used in symptoms management. However, in the contemporary society, this type of symptoms management is used as complementary to the first method. Professionals normally recommend it in case the patient is not responding positively to recommended drug treatment (Grace, 2013).

Analysis of Ethical Common End of life Concepts and Problems

Two common approaches of end of life are palliative and hospice care. In this paper, clear view of these forms of care to end life has been provided. They have functional differences as outlined below.

Palliative Care

The main objective of palliative care is to relieve patients of their symptoms which also form one of the healthcare’s major objectives. Patients who are either terminally or seriously ill are subjected to palliative care because it aims at taking care of all the patient’s needs. Some of the needs of seriously ill patients include emotional, psychological and social wellbeing, management of symptoms and pain. There is minimal difference between palliative and hospice care as we will discover later in this essay. Both palliative care and hospice care provide patients with comprehensive care through use of interdisciplinary professional team. The only difference between palliative and hospice care is that while hospice care is restricted to patients glaring end of life, palliative care can be used for long term health care settings as wells as in patients in acute health conditions. Palliative care is not common in the traditional medical practice in the United States of America because its main focus in relief of symptoms does not form primary objectives of the American health care system. Provision of healing to injuries and treatment of illnesses form the main focuses of the American health system (Quill & Abernethy, 2013).

The following are two of the ethical issues raised through use of palliative care in patients: first of all, it is of benefit to the patient because it helps in pain relief to the patient nearing end of death; and secondly, it does not cause the patient any harm but relieves him or her temporarily of the sufferings. Since palliative care addresses both two ethical issues, it is recommend for patients nearing end of life because it relieves them of pain and other symptoms which may cause them to suffer. It is however, important to note that no so many patients chose to undergo palliative care when they near end of life (Grace, 2013).

Hospice Care

Hospice care is normally chosen over by patients who near end life. It involves development of a hospice care team comprised of social workers, nurses, doctors among other healthcare professionals with an aim of making the final day of the patient as comfortable as possible. Some of the factors addressed by hospice care include provision of quality life, management of symptoms, control of pain and allowing the patient to experience natural death.

Hospice care gives the patient an opportunity to experience good death when that time comes. The patient and his or her family members have opportunity to control circumstances and situations pertaining to the patient’s death. Members of the hospice teams are charged with the responsibility of providing their patients with hospice care wherever and whenever. Grief counseling in case of death, social services, nutritional counseling, and provision of spiritual and emotional support are some of the functions carried out by hospice team apart from medical care.

Ethical Issues of End of Life/Dying Care

Antibiotic treatments

Patients who near end life are prone to infections due to reduced immunity. High percentages of seriously ill patients are also subjected to antibiotic treatment. However, it is not a guarantee that these patients are relieved from these drugs in fact most of their symptoms end up alleviating. The situation may worsen to an extent that it would be pointless to administer antibiotic treatments to these patients.

This is where medical practitioners are faced with ethical dilemma. They are torn between withholding and continuing with administration of antibiotic treatment. Since antibiotics are part of the treatment routine and should be administered to seriously ill patients no matter the side effects. Most healthcare providers tend to continue with administration of antibiotic drugs because they believe that the side effects are due to treatable diseases but not to untreatable illness. Another ethical issue that has been raised on the use of antibiotic treatment on terminally ill patients is the capability of the bacteria to undergo mutation. This would make the patients resistant to antibiotic treatment hence exposed to several other infections. Public health professionals have carried out research studies and determined that over-prescribing antibiotics to terminally ill patients because it would make them susceptible to other infections (Cook & Rocker, 2014).


This is an ethical issue which allows a physician to actively or passively terminate the life of a terminally ill patient upon his or her consent or that of the family members. This method was designed due to the grief that struck family members whenever their patients were ill for a very long time. Passive euthanasia is mostly by physicians to terminate the life of their seriously ill patients to save them from continued suffering. It involves denying the patients important medical intervention such as services of life supporting machines. The society views passive euthanasia as way of allowing a patient to die in peace. Active euthanasia takes place when the physician takes physical actions when terminating the life of the patient. The most common action that physicians use to carry out active euthanasia is giving the seriously ill patients injection of lethal drug (Sprung et al., 2014).   

Some of the ethical issues on euthanasia include the following: it is not morally right to terminate the life of an individual even upon request; passive euthanasia is acceptable to the society in case continued life would cause more harm to the patient; euthanasia is perceived unethical in the modern society because it may open room for unfair and unjust practices; and violation of the patient’s right to life in case euthanasia is executed.

Advance Directives

These are documents prepared by patients and their family members giving specific instruction concerning their treatments. Palliative care and organ donation are some of the common advance directives across the world. Advance directives have been used by patients near end of life to request their health care providers to terminate their lives in order to avoid more suffering. They understand the fact that their health conditions cannot be reversed and their ultimate end is death. It is pointless for them to subject themselves to increased suffering while there is little hopes for normal life (Grace, 2013).

Advance Directives Ethical Issues

The following are some of the ethical issues pertaining to advance directives on patients near end of life/ dying care: patients who are not yet terminally ill may make advance directives that would compel their health care providers to stop providing necessary heath care services subjecting to early death and more suffering; advance directives require a lot understanding from healthcare providers hence wastage of time (Brinkman-Stoppelenburg, Rietjens & van der Heide, 2014).

Terminal Sedation

This is a method that is used by physicians to sedate patients who near end of life. It is used to ease their suffering from pains and sorrows they experience at their condition. Physicians administer sedatives to their patients who are seriously ill to a point whereby they become unconscious. These sedatives are administered to tranquilize the spinal cord and brain of the patient making them motionless and eventual death (Cook & Rocker, 2014).

The following are some of the ethical issues that are associated with terminal termination as an ethical issue: terminal sedation may cause the patients to die faster than anticipated; it does gives precedence to suffering rather than consciousness; it raises question on the extent to which individuals are willing to go in order to relieve themselves of sorrows associated with dying care; and finally it raises question whether the family members may abuse the right of the patient and seek for terminal sedation on their behalf (Cook & Rocker, 2014). 


This is a statement that is provided by the physicians offering either hospice or palliative care to patients near end of life. It states that a patient can only live for duration of not more than six months. It enables the patients to receive Medicare hospice benefit but it also raises ethical question whether it is accurate, or whether six month limitation is necessary (Grace, 2013).


In conclusion, it is difficult to decide on the best heath care method should be administered to patients near end of life. I believe that hospice health care is most suited for terminally or seriously patients. Euthanasia, sorrow management, terminal sedation, prognosis, advance directives and antibiotic treatment are some of the ethical issues which have been addressed in this paper. I agree with the thoughts of most of the healthcare professionals who think that despite these actions being of benefit to the patients who near end of life, they also have negative impacts on not only the patients but also their family members. Health care personnel should also review their ethical principles before they can practice these methods on their seriously ill patients. Finally, I would suggest that some of these ethical issues are more important in health care system and cannot be ignored. It is high time the contemporary societies recognize essentiality of these issues and accept them. They provide the desired solution to both the patient and his or her family members.


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