3-6: Psychological Issues in Advancing Illness

Question 1

Explain why patients with end-stage renal disease decide to discontinue kidney dialysis.

Answer 1

A recent study of patients found that the decision was not influenced by a major depressive disorder or by ordinary suicidal thought, but rather represented a decision to forego painful therapy.

Question 2

Discuss the significance of the U.S. Patient Self-determination Act and the Oregon Death with Dignity Act.

Answer 2

In 1990, Congress passed the Patient Self-determination Act, requiring that Medicare and Medicaid health care facilitates have written policies and procedures concerning patients’ wishes for life-prolonging therapy. These policies include the provision of a Do Not Resuscitate (DNR) order, which provides explicit guidelines regarding their preference for medical response to cardiopulmonary arrest.
In 1994, Oregon became the first state to pass a law permitting physician-assisted suicide. Generally, at the patient’s request, the physician provides a lethal dose of medication or sleeping pills that the patient can then ingest to end his or her life.

Question 3

Explain why a breakdown in communication may occur between terminally ill patients and their families.

Answer 3

First, death itself is still a taboo topic in our society. The issue is generally avoided in polite conversation; little research is conducted on death, and even when death strikes within a family, the survivors often try to bear their grief alone.

A second reason that communication may break down is because each person involved may believe that others do not want to talk about death.

Question 4

euthanasia

Answer 4

Ending the life of a person who has a painful terminal illness for the purpose of terminating the individual’s suffering.

Question 5

living will

Answer 5

A will prepared by a person with a terminal illness, requesting that extraordinary life-sustaining procedures not be used in the event that the person’s ability to make this decision is lost.