By Adrian Allotey
Eldercare Specialist/Aging Companion/End of Life Doula
You Are Not Alone Elder Care LLC

Clinically managed end of life care is increasingly becoming a hot topic for discussion. Providing care for fragile elderly patients nearing their transition from this world goes beyond learned skills. Medical personnel responsible for providing this specialized care must have an innate sense of attention and dedication to the entire process, the humanistic part in particular. Despite the countless legal and ethical concerns associated with end of life advocacy, the family, patient, and in my case, end of life doula’s role as advocates all come to play here. With ten percent of all US healthcare spending going into the end of life care, it proves why many Americans are increasingly becoming interested in experiencing a period of care before death.

How End of Life Advocacy Has Been Transformed

Since the 20th century, and with advancements in science, medicine, and medical engineering, health professionals have occupied a lot of space where the family and community formerly filled. Care for a dying patient can be managed and made less painful with innovative medical technology. An end of life doula can also have prominence in cases such as these by advocating through the entire transition process.  

For years, end of life doulas have researched ways to enhance the quality of life for all parties involved in the various stages leading to the death of the patient. For this reason, advocacy is a fundamental feature of end of life care. The assistance and sensitive care provided in this period can assist in determining the quality of end of life. More importantly, this relationship is dependent on support and information from the person who is passing and their medical team. 

What Happens to The Patient During End of Life Care?

Patients can exhibit total dependency traits, powerlessness, and helplessness in their final moments. Some may lose continence, the ability to speak, or exercise self-control. This is where advocacy begins. The  end of life doula can represent them and communicate their wishes. It becomes even more crucial when the patient’s initial diagnosis rapidly declines.  

Hopefully by this time, patients have taken steps to create advanced directives for their end of life decisions; giving explicit consent for medical choices if and when the time comes.  The patient may authorize a surviving spouse, child, or family member to make these final decisions on their behalf. Admittedly, these are tough decisions to make and may require end of life doula intervention and support.

Ethical Dilemmas

Although the reasons for end of life care are justifiable, they still have ethical dilemmas. There are problems with compromised patient self-sufficiency and communication failures. Meanwhile, of great concern is the issue of symptoms management. It usually brings up the inquiry of whether symptom reliefs prevail over likely risks and side effects.

Shared decision making can also be of great concern. It happens when more than one person is involved in the final choices. Indeed, it has been noted that significant others may fight against the patient’s wishes. However, the crucial choice should be a sign of respect to the dying individual.

Advanced Directives such as the medical power of attorney, “Do Not Resuscitate”  and POST form are vital elements to discuss before the patient gets worse and cannot make decisions. Advocacy at the end of life has come to stay, and more Americans are beginning to see it as a means to a decent and comfortable death.