Factors Affecting Opinions On Life Support Issues

Essay, Research Paper

ABSTRACTThe purpose of this paper is to examine the relationships among cognition, life satisfaction, demography, and attitudes regarding life support among the elderly. The goal is to provide information that would be useful in developing programs and policies for the elderly in a variety of settings. A study using sixty-six male and female subjects was used for much of this research. In this study the subjects were asked to respond to the following instruments: The Life Satisfaction Index, the Mini-Mental State Examination, the Values History questionnaire, and a demographic questionnaire. One finding of this study was the majority of the subjects preferred quality of life over quantity of life and did not wish to receive artificial respiration or nutrition, although half wished to receive cardiopulmonary resuscitation (CPR). INTRODUCTION People age in different ways. Some reach old age with prestige, affluence, and comfort; others face age wrought with hardship and difficult circumstances. The more unfortunate face poor health, declining mental function, inadequate financial resources, and loss of loved ones. Many issues regarding the aged have come into public focus. One concern that has gained prominence is that regarding whether or not a person should be kept alive when faced with imminent death or total incapacitation.(Crane, 1975) Many people express the wish that heroic or extraordinary efforts not be used if the life to be maintained would be of very low quality. Desires related to this issue may be expressed in advanced directives, or living wills. Advanced directives have been available but are not widely used, and there are problems regarding their use and interpretation.(Doukas and McCullough, 1991) There is considerable variation among the elderly so it can be expected that there will not be uniformity regarding issues such as the desirability for life support. It will be useful to identify factors, such as degree of life satisfaction and mental competence, which may affect opinions about life support. The purpose of this paper is to clarify factors which relate to a person’s feelings and opinions regarding life support issues. The intent has been to look at the factors of mental competence and life satisfaction as they affect opinions regarding life support. Demographic factors were also considered. It is hoped that this knowledge will enhance the ability to deal effectively with the elderly and improve the understanding of the related issues. DISCUSSIONOne issue is the effect cognitive status may have on the wishes of the elderly regarding life support in the face of imminent death or extreme disability. One ethical question which may be raised is whether to follow the instructions of an incompetent individual in the same way as those of an individual in good mental condition. The court, however, has determined that the rights of the competent and incompetent person are the same in regard to the right to decline life-prolonging treatment.(Annas, 1978) Another issue is the relationship between a person’s opinions regarding life support and that person’s general satisfaction with life. Is a person with a high level of life satisfaction more or less likely to choose artificial life support in the case of life threatening illness. The right of competent patients to forego life-sustaining treatment has been upheld in the courts and is generally accepted by medical ethicists.(ibid) This relates to the principle of autonomy and self- determination. The person’s ability to make the decisions related to life support depends on his or her ability to understand the relevant information, reflect on it in accordance with his or her values, and communicate with caregivers.(ibid) Making decisions regarding life support is one of the most difficult decisions in medicine but health care providers are concerned about providing inappropriate care to patients near the end of life and about inadequate participation by patients in end of life decision making. One reason for withholding resuscitation is that the quality of life expected after resuscitation would be unacceptable or that the patient’s current quality of life is unacceptable either to him or her, or the family if the patient is incompetent.(Sprung, 1990) Questions raised by ethicists are: do quality- of-life considerations undermine and override the sanctity-of-life ethic and do quality-of-life and quantity-of-life represent opposing values.(ibid) We may even be moving toward acceptance of active euthanasia. Patients who are severely depressed or in pain might wish for death, but be thankful for life once the pain or depression is eliminated.(ibid) Many hospitals have established ethics committees to provide advice to physicians, patients, and families when difficult decisions arise regarding life support. These committees provide guidance in difficult situations. It is generally agreed that it is desirable to know a patient’s wishes regarding cardio- pulmonary resuscitation and other life support measures; action, however, is frequently not in accordance with this philosophy.(Schonwetter, Teasdale, et al, 1991) It has been shown that prediction of a person’s wishes regarding resuscitation preferences may not be accurate. The physician or family member often has an erroneous concept about the person’s wishes. Furthermore, it has been found that following a person’s advanced directive may not reflect that