NURS1137 Case Study: Melissa and End-of-Life Care Decisions

This case study focuses on Melissa, a 37-year-old woman with stage 4 bowel cancer and liver metastases, exploring her palliative care journey and end-of-life choices. The study examines Melissa's right to determine the time and place of her death within the framework of Victorian law and the Australian charter of healthcare rights. It delves into the complexities of her situation, including her family dynamics, advanced care planning, and the challenges of home-based care. The assignment analyzes the legal and ethical considerations surrounding end-of-life decisions, patient rights, and the role of healthcare professionals. It highlights the importance of clear communication, patient autonomy, and the impact of various factors on the final decision, including family support and the availability of resources. The study also touches upon the practicalities of implementing end-of-life wishes and the potential challenges in achieving them, particularly the preference for dying at home versus in a hospital setting.

Running head: DETERMINING TIME AND PLACE TO DIE. 1
Right to determine time and place to die
Student’s name
Professor’s name
Institution of Affiliation
Date

DETERMINING TIME AND PLACE TO DIE. 2
Introduction
Under the new health care plan, which is used by Victoria state, a citizen can enjoy a
variety of benefits. Patient under palliative care and end-of-life are inclusive too in the
framework. The main aim of this framework is to provide Victorian with better explanations
about end-to- life care. Also, the framework strive to make palliative care and end to life services
sustainable and sufficient. Melisa who is under palliative care and also nearing end-to -life can
benefit from this framework (Pereira, 2013). The end of life project funded by the Ministry of
Health and Human Services, for a three-year plan (2017-2019), aims at building social capacity
in end-of-life support especially by the help of the local governments' hierarchy and networks.
This project can help Mellissa, especially in matters that guide her on thinking of a better
approach to death and bereavements (Anon, 2012). Looking at Mellissa’s case, it is right to say
that she is ready to plan a better way to die. Mellissa is chronically ill, and the liver metastases
percentage of living is usually below ten percent (Frilling, & Clift, 2014). In this case study, the
focus will be on the palliative care and end-of-life programs and how Mellissa has access to the
right of determination on the time and place she wants to die
End-to-life care
In our case, Mellissa is affected by liver metastases, and she also has bowel cancer.
According to the Australia Cancer Council Bowel cancer account for the second-highest number
of deaths which occurs in Australia. The screening program, however, encourages that, bowel
cancer is treatable if detected earlier (Grogan & Olver, 2014). But in our case, Melissa has been
suffering, and she is now at stage four of the bowel cancer. Therefore, palliative and end-to life
care are suitable choices for Melissa. In our case, Mellissa right to when and where she will die

DETERMINING TIME AND PLACE TO DIE. 3
falls under end to life care. End-to-life care refers to the attention given to patients who are in the
last phase of their lives. End to life care is offered in a civic, respectable, and culturally
acceptable manner. This case focuses on the right of determining when to die and the place, end-
to-life care offer a solution. Under the end to life care, Mellissa will be in a position to provide
her wishes and preferences which must be respected by the person offering care to her (Holman,
2014). In fact, end to life care give patients a choice to determine where to receive care and when
to die
What to expect from end to life care?
End to life care is tailored to provide patients with the ground to determine their death; it
considers a patient decision and the family. Mellissa parents, as outlined in the case study, are a
far way from Victoria. Therefore, sharing her choice under the personalized care plan can be
made to the family members, including her children and the parents. End to life care gives
patient dignity they require in their lives. Patients can choose what they want with their lives.
They have the right to refuse the provision of medication and food (Anon, 2012). It also
provides Mellissa with many opportunities to include her children. Joshua and Emma are young;
therefore, they are entitled to honest and age-appropriate data about their mothers' condition
(Deith, 2013). The end to life care will also provide grounds in which Mellissa can choose an
overall decision-maker on her behalf. The decision-maker will be given the mandate to offer a
decision in the event Melisa cognitive abilities will be failing. Clear Communication is thus
needed.
Victorian law on assisted dying

DETERMINING TIME AND PLACE TO DIE. 4
Because our case focuses on the right of a patient to determine when to die, Victoria law
which came into effect earlier this year provides a solution for this scenario. The requirement for
this law is that, a patient should be above 18 years of age, which Melisa is eligible since she is
thirty-five years. The patient should also have less than six months left to live. The expected
results, according to our case, is death. The law, therefore, means that terminally ill patient like
Mellissa has the right to determine when to die. It can be done using lethal medication. The bill
also makes Mellissa the right candidate since she has been a Victoria resident (Anaf, 2017). The
minimum required duration of stay in Victoria, to be eligible for this offer is 12 months.
Therefore, under this legislation, Mellissa wish and preferences of determining when to die are
taken care off.
Reason to consider ending of life (when to die)
Australian law provides guidelines or basis which should be taken into consideration
before the ending of life choice is required. The first requirement is that the patient is in adverse
pain and therefore request the doctor to release her (Mellissa) from the agony. The second
situation looks into the patient decision and preference. That the patient is willing to die and
therefore request the doctor’s support. In this latter situation, if considered by Mellisa, she will
be taken through various prescription and advice (Beardsley, Brown, & Sandroussi, 2018).
However, the end of life, at this level requires the performance of the patient only. He or she is
the one who administers the lethal act. The latter situation looks into the patient wishes; if the
patient wants to end her life or not. If Mellissa considers this choice the doctor administers pain
killers in overdose to increase the death process.
Preferred place to die

DETERMINING TIME AND PLACE TO DIE. 5
Mellissa, according to our case study, has enrolled in advanced care planning. This
personalized care provide patients with the ground to air their values openly. The main goal is to
plan ahead. Melissa can air her preferences on the time she wants to die and where she would
like to die. However, according to a survey, most Australian don't die as they wish. Most of them
die at care facilities. Death in residential caring centers continues to increases compared to death
at home. According to Broad, 14% of Australian residents die at home. Fifty four percent die at
the hospital, and 32% face their deaths at residential care (broad et al., 2013). It is correct to say
Melisa has the time to plan and prepare for where to die but, is this possible in Victoria?
Considering that Mellissa is under advanced care in a hospital means that the choice is difficult
to predict. On the other hand, we can predict the preferred place Mellissa would want to die, her
home. Therefore, to have a favorite spot when she would want to die, Mellissa is required to lay
a strategy for death in advance (Gomes et al., 2015). Therefore, having this choice should be
included in a legal framework like a will to ensure consideration of her decisions. Thus, in an
advanced care setting, Melisa needs to express her views which relates to family, religion, or
personal opinions of dying in the hospital (Palesy et al., 2018). In this instance, if we choose
Melisa home to be the preferred choice for her to die, the decision should be included in a will to
help the healthcare professional terminate the treatment.
Inclusion of personal decision in the will
A will is a legal statement that can assist Mellissa in an event her cognitive abilities are
failing. She can name a person who in any given circumstances, will be able to air her view and
decision. In other terms, a will act as a personal voice made in writing. Although a will is not a
requirement when choosing when to die, it may give Mellissa the ground to offer her decision to
physicians regarding when and where to die. However, the system of administration in Australia

DETERMINING TIME AND PLACE TO DIE. 6
has been marred with claims of not meeting patients and family needs and preference when
executing the end of life.
Does the patient have choices about death place?
We can answer this question by looking at Mellissa preference. The right to exercise her
time of death and place of death. Looking at her case, it’s true Mellissa is under palliative care
offered at the hospital. Most people in Australia, just like Melissa, are hospitalized each year.
The main reason behind the hospitalization is palliation. This scenario leaves us with one choice,
dying at home. A lot of money is spent on providing health services in Australia. However, the
health cost doesn’t involve treatment cost of an individual at their home. Therefore, providing
home-based care for Mellissa who is under palliative care is almost impossible. Looking at
Mellissa scenario, home-based care can be costly and traumatizing to the family (Ghesquiere &
Bagaajav, 2018). There is a great geographical distance between her and her family members.
Mellissa's parent dwells in Queensland while her in-laws are four hours drive from Victoria. The
nature of the relationship also makes home-based care difficult since her parents are aged and
have a chronic illness. At the same time, there's a divorce between her and Daniel. If the choice
of place to die were home, it would be costly for the family. Because this matter takes both
political and health dimension, it is right to say that most Australians like Mellissa will continue
to die in hospital rather than their homes.
Rights of patients in Australia
The Australian charter of healthcare right applies to all citizen, including Victorian. This
charter describes the power and privileges of the patient when there under palliative care and
hospitalization. The core value of the charter is respect (Moore, 2018). The reason for choosing

DETERMINING TIME AND PLACE TO DIE. 7
this value is to relate Mellissa’s situation with the available choices, the right to die when she
wants and the place she wants. Patients like Melissa have the universal right to be treated with
respect. This respects include to get the care that relates to believes, and culture one affirms.
Mellissa under these guidelines is respected regarding the medical practices given to her, which
may revolve around illness and death. Patients like Melissa have to be included in a discussion
that explains how she will leave the hospital. Therefore, under these guidelines, we can say that
Melissa decision to air her place of death can be possible (Schwartzberg, 2011). However, under
the circumstances, if a patient discharges herself in the hospital, he or she is supposed to take
responsibility of the outcome.
Conclusion
It's true to say, according to the discussion that Mellissa rights and privileges are upheld
in the Australian charter and Victorian laws. The right to determine when to die is accepted in
the Victorian state. Thus, make Melissa right to determine when to die come true. However, we
have also noted that the ending life decision can’t be easy since it involves a lot of requirements.
Besides, the general views and choice of family members may be in reconsideration, but a
patient decision is paramount (Haines, 2011). In this case study, the right to determine where to
die seems difficult and challenging. The death process is unpredictable. It can happen at any
given time and place. As discussed, numerous deaths usually occur in hospital, meaning a choice
of another location might be difficult. Considering Mellissa's situation, her chronic and terminal
illness are deteriorating, and the need for suggesting proper advanced care to her. In regards to
rights, respecting patient rights should be in a manner that doesn't lead to defamations of a
physician name during the execution of the said rights. Right to end life is possible. Right to
determine where to die, is unpredictable (Schwartzberg, 011).

DETERMINING TIME AND PLACE TO DIE. 8
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