Renegotiating and Reinforcing Appropriate Care: Personal Reflections

This essay delves into the multifaceted aspects of end-of-life care, examining the perspectives of physicians, patients, and their families. It addresses the evolving views on aging and terminal illnesses, shifting from past practices to more realistic and personalized services. The author, a physician, reflects on personal experiences, including discussions about life-sustaining interventions and the emotional toll of witnessing death. The essay highlights the importance of personalized care, the challenges faced by healthcare professionals, and the ethical dilemmas surrounding end-of-life decisions. It discusses the role of family, friends, and healthcare staff in maintaining the dignity and respect of individuals nearing the end of their lives. The author also reflects on the limitations of medicine in addressing old age and death, and the significance of pastoral care and support for both patients and their families. The essay concludes with a call for devotion and dedication in the service of others, emphasizing the need for ethical considerations and autonomy in end-of-life care.

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THE RENEGOTIATING AND REINFORCING APPROPRIATE CARE
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Introduction
Mortality is one of the undebatable paths of life that one must undergo. Modern trends
have given rise to a different view of aging and terminal diseases, not as a stage of life but rather
some illness. The new point of view has led to shift from the past end of life care practices to
more realistic services. More attention is currently emphasized by the health care experts.
Involvement with individuals at the last years of life is a universal duty which we all have to play
a role. My experience as a physician with patients and their families convincing them to end the
life-sustaining intercessions has taught me a lot. I have called relatives to the hospital and
watched them grieve at the death of their beloved. Although this is not a light duty, what
comforts me is that I play a role in the patients and their families at the most critical point of their
lives. Mourning, sadness, confusion, grief and all the emotions that every individual adopt after
death is announced at times get me caught in the trap. This has made me adopt different
viewpoints about death and life each time a person dies.
Summary
Physicians have many discussions about the end of life to engage in some of which may
be addressed through legislation. The development and funding of end of life in hospitals are
highly regarded by the National End of Life Care Program. Health care homes are considered the
best environments for the end of life care (Abhay, 2016). However, the public is still uncertain
about the practices at the end of life care homes. The community knows little about how much
care is given to their patients. The question about whether their needs are well met remains a
controversy.

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Experts at the end of life care departments often emphasize on the centrality of a
personalized care (Butcher, 2010). The care homes staff may be knowledgeable of the primacy
of personalized care to their clients but fail to sustain an individualized care. Sparing time to sit
with the dying individuals and ensuring their comfort may not simply be met possibly because of
the limited staff. Handling every patient individually could mean that some will stay unattended.
Establishing informal relationships with the residents helps create a motivation and avoid
withdrawal (Butcher, 2010). The building of personal relationships makes the staff more
approachable which makes those on their way out more reassured.
The individuals living their last days need to maintain their dignity and respect
(Duderstadt, 2013). Family, friends and the staffs in the health care facilities should help the
patients sustain their self-respect by paying attention to their needs and their interests. This can
be enhanced by helping maintain their cleanliness, assisting them in keeping their hair neat and
offering other services such as pedicures, manicures and trimming their chin. Respect can also be
shown by recognizing and acknowledging personal, ideological and cultural differences
(Duderstadt, 2013). Care providers ought to put aside their own beliefs, faiths and ideological
subscriptions in service of their clients.
Medicine has proved triumph in many instances of life: preventing and curing diseases,
making births less painful and conquering related complexities (Morley, 2013, p. 616). However,
the elephant in the house is curing old age and death. Mortality has overweighed the strength of
any existing medicine. At times the medicine even tends to intensify the suffering. Although all
the efforts made by medical practitioners in these critical periods are meant to lengthen one's
lives, not all have proven any success. When the medical attention offered does not bear the

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desired outcome, a crisis is bound to occur between the specialists and the affected families
(Morley, 2013). Ideally, this is not the fault of the doctor. The uttermost goal of any medical
practitioner is the satisfaction brought about by saving lives (O’Neill & O’Keeffe, 2010, p.
1282). Nobody delights at death. This then raises another controversy of whether those nearing
their last days should be kept in the hospital or dismissed. However, the health centers mostly
decide to take all blame but do the best to save lives.
End life choices whether to withhold or to withdraw from the life-prolonging treatment
for dying patients is a familiar dilemma (Ewegen, 2012). Ideally, people undergoing their last
years or their last months of life should be given maximum care and helped to live as well as
they require and with dignity until their last second. Care providers should be sensitive enough to
their needs, wishes, and preferences. Identifying this will help them to adequately plan for the
client’s care. This care is not only restricted to personal needs but also the external environment.
The people who matter the most to the person should also be shown some concern. The family
members who are most important to the client should also be supported. This support
encompasses all physical and emotional needs. Many family members are literally not aware of
how to react in the face of death. This may affect both their emotional and physical behavior
especially when they recount their relationship and the experiences with the victim (Ewegen,
2012). This might be caused by either by a feeling guilt or remorse. The tension is likely to be
heightened by a conflict among the family members either about a decision to be made or legal
measures. This calls for an external intervention, particularly by the spiritual experts. The
significance of pastoral care at the end of life is to help the involved cope up with the situation.

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Reflective Experience
The duties I am usually attached to in my field of practice, have helped me learn how to
conquer medicine related conditions regardless of their weight. I had long thought all been easy
to accept especially due to numerous encounters with death and still births. It was until when I
had a real experience with my grandfather that I realized that training and experience were not
enough.
Living with grand parents can be an interesting experience, more interesting when you
can share some experiences or even go for some walks together. However, it can be a great
nightmare which you would want to escape by all means. Everyone would love to see their
beloved ones happy. When lives move them violently them to the point of non-contentment, we
pity them and even pray that God can give them a rest. Death, though undesirable becomes the
best rescuer. When the encounters turn to be unbearable, and beyond our intervention, the
comfort we previously had disappears. In the recent past, I had an experience with my
grandfather battling with his old age.
Old age is an enemy who comes forth with much more shortcomings: loss of hearing,
sight, memory and best friends. It is also attached some chronic illnesses such as diabetes, some
forms of dementia and heart failure. The experience with my grandfather has never been the
best. It has taught me a lot about aging and death. Although I have always been his favorite, old
age deprived him the intimacy we once had. When he hit a hundred years, he could not recognize
anyone, not even his sons. He had lost most of his senses. The once active, independent and
jovial grandfather was unable to see. He could not maintain substantial conversations. He had to
be carried from place to place. He lost his ability to touch and had to be fed, washed and dressed

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up. He was always emotionally disturbed and constantly claimed to have all sorts of physical
pain. Though we tried as much as we could to make him comfortable, this could not amount to
any significant change. His suffering and physical pain were heightened by the poor life he had
lived in his past years. He had had a series of accidents breaking his joints and weakening his
muscle. He had also been an aggressive smoker and drug addict. This would have robbed him his
life much earlier if the doctors had not discouraged him from such habits. This did not stop
immediately; we had to practically keep him off from using drugs.
Although I was a training medical practitioner, I was unable to cater for all his needs. He
grew more demanding as days passed. Hospital visits multiplied as the days passed. The charges
heightened day by day though no much change was evident. Relatives and friends continued
draining their bank accounts to cater for the huge hospital bills. Despite the fact that we were
sure that medical attention would not cure the condition, we had to remain loyal to our
community. However unfixable the matter was we had to show some commitment. The modern
societies highly denounce neglect to the aging. Mishandling them may attract severe legal
measures. The families and societies attached to the old person have a responsibility to ensure
that their rights and freedoms are observed and their dignity preserved. After a long battle with
grandpa, he finally passed away. The reactions were very different from each family member.
Women wailed while men tried to keep some calmness in their faces. We were greatly pained by
his demise but gained comfort from the fact that he had rested. In my opinion, we should not put
a lot of pressure to the old. We should not coerce them into living as this may cause them more
pain than death. I do not see any sense in holding them back in their suffering.
The transitional challenges attached to patients, caregivers, health providers and families
are as a result of the organization’s practices and cultural attitudes (Samaraweera1 & Maduwage,

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2016). The ethical dilemmas we are faced with in life call for a series of questioning ideologies
to come up with the most appropriate. According to Abraham Maslow in his hierarchy of human
needs, the highest level is self-actualization/self-fulfilment. He suggests that the greatest need of
any individual is the passion to help other people achieve their full potential. This can result in a
more complicated controversy. Do those people who live beyond their independence attain their
self-actualization? The answer could be definitely no. Hypothetically, people who live beyond
their nineties become some form of loads to their loved ones. They are fully dependent on them
in all aspects ranging from financial assistance to the most basic personal chores.
End of life care homes may or may not be the best places to face death (O’Neill &
O’Keeffe, 2010). Personally, I would recommend that if one has to face death, let it be with
dignity. If the patient gets adequate care and services, I can recommend them. The greatest
trouble comes in when these stations are flooded, and the patients' needs cannot be met at a
personal level. In the cases where the care homes do not work to one’s satisfaction, alternatives
such could be adopted. Keeping patients at the hospitals might be considered as an option but
only in areas with adequate infrastructure to accommodate the clients (Han, 2012). In many
cases, family and friends opt to keep the victims at home. If adequate care and attention is
assured, this has no harm. End of life care does not necessarily require specialists. Training and
experience at this juncture in life are of limited importance. The most basic ingredient is the
devotion and dedication in the service of others. In this event, the medical practitioners can
hardly be termed as the only superior beings.
The medical specialists in the face of mortality undergo numerous dilemmas. A slight
error in the medication could cost the life of the patient (Yousif, Hussain, & Mhakluf, 2010).
The professional ethics require them to safeguard human life at all costs. At the same time, the

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interests of the clients must be safeguarded. The lack of autonomy amongst the elderly and the
terminally ill in our societies may attract different perspectives on how they should be treated.
We may wish the past a hundred happy birthdays without considering whether our sentiments
please them or not. Why don’t we consider if their life is appealing to them? We might be happy
about their life not considering their comfort.
Conclusion
In conclusion, collaboration should be established between the patients, the relatives, and
the healthcare providers. At times, the physicians and the family members are faced the
responsibility to make decisions which might affect the patient's life to a great extent. Such
includes deciding on where the patient should spend their remaining part of life. The most
appropriate decision has to be reached, and the patient must be comfortable with it. This bond
enhances the openness amongst the parties helping to get the best outcomes from the
relationship.

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