A Case Study on Death and Dying: End of Life

Case study – end of life decisions

Death is an inevitable for every human being. However, advancements in health sciences have changed the norms of the concept of death in end of life care. In fact, these advancements have presented the capacity to intervene when faced with natural death so that human beings now have the capacity to prolong their lives (Black, 2016). Although these medical advancements can change the circumstances of natural death though sustaining life, they do not offer recovery promises and rely on secondary support so that patients cannot have meaningful existence. As such, patients are now empowered with the important task of making choices at end of life care over the circumstances of their natural death. These decisions often shift between foregoing treatment and letting the natural death process to proceed or prolonging human life through medical technologies (Heinrichs, Oser & Lovat, 2013). The present paper discusses’ the ethical implications of the decision options available to a patient receiving end of life care.

Question 1. How would George interpret his suffering in light of the Christian narrative, with an emphasis on the fallenness of the world?

The Christian narrative looks at suffering as a necessary tribulation for every person seeking to enter the kingdom of God. In fact, all Christians must have suffered in the past, are suffering or will suffer in the future (Acts 14:22, NIV). This is the reality of the world and an acknowledgement that humans live in a world of death, mourning, pain and tears. The only way in which humans can escape suffering is to get into paradise where they would be no more death, mourning, pain and tears. Still, Christians are required to accept that suffering is not without purpose or random, and is intended as an earthly experience that redeems the physical body (Revelations 21:1-4, NIV). 2 Corinthians 4:8-9 further explains that all humans will suffer without levels that they can bear, and that suffering does not imply that God has forsaken them. Also it mentions that suffering can be of the spiritual, emotional, physical or mental nature, and that Christians should accept whichever form of suffering that comes their way as this equips them for ministry (2 Corinthians 1:4, NIV). Besides that, suffering is considered as a battle in which the worthy Christians stand out as deserving of God’s favor and mercy (Job 2:9-10, NIV). Also, Christians should view suffering as a transient state that prepared them for glory (2 Corinthians 4:17-18, NIV). In this respect, the Christian narrative looks at suffering as a transient state that reflects the fallenness of the world and prepares Christians for eternal life.  A Case Study on Death and Dying: End of Life

Question 2. How would George interpret his suffering in light of the Christian narrative, with an emphasis on the hope of resurrection?

George should interpret his suffering as fulfilment of the Christians scriptures when God warned that rebellion in the Garden of Eden would be unavoidable death (Genesis 2:17). Through undergoing suffering, he is constantly reminded that he lives in a world of death, mourning, pain and tears. By accepting the suffering, George becomes worthy of God’s favor and mercy, and will enjoy eternal glory in heaven. Overall, the suffering that George is experiencing is not without purpose and is an earthly experience that redeems his eternal body so that his spirit is saved for heaven (Newton, 2015).

Question 3. As George contemplates life with amyotrophic lateral sclerosis (ALS), how would the Christian worldview inform his view about the value of his life as a person?

The value of George’s life as a person is intrinsic since it is derived from God as every human was made in the image of God (Genesis 1:26-27, NIV). In fact, life is God’s gift since God breathed life into Adam (Genesis 2:7, NIV), and only God has the right to withdraw that breath and cause the death of any person (Job 34:14, NIV). The implication is that all life belongs to God and an individual is just the steward of his or her life. Consequently, George should not contemplate taking his life as he is accountable to God and taking his life would make him subject to God’s judgment and punishment. Besides that, Exodus 20:13 and 21:12-32 clearly teach that life is precious any death resultant from negligence, carelessness or intentional killing will be punished by God. As such, George should guard and cherish his life as a gift from God.

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Question 4. What sorts of values and considerations would the Christian worldview focus on in deliberating about whether or not George should opt for euthanasia?

As a result of Adam and Eve’s fall in the Garden of Eden, physical death is now inevitable for all Christian (Genesis 2:17, NIV). It is not uncommon for the process of dying to be accompanied by pain, suffering and illness. Still, Christians must accept everything that comes with the process of dying since the sixth commandment prohibits euthanasia regardless of the circumstances (Exodus 20:13, NIV). This principle is seen in the story of King Saul who was fatally injured and sought euthanasia in order to escape humiliation and suffering from his enemies. His armor bearer refused to kill him since he respected God’s commandments (I Samuel 31:3-5, NIV). An Amalekite killed King Saul in order to end his misery, and brought the information to King David who ended up killing him (2 Samuel 1:1-16, NIV). This is an indication that irrespective of the circumstances, all Christians must respect human life and not consider euthanasia as an option.

Question 5. Given the above, what options would be morally justified in the Christian worldview for George and why?

The dignity and value of human life is derived from God who created all humans in his image. As a steward who guards the life God gave him, George must uphold the sanctity of his life until his death. Ending his life in order to relieve the inconvenience of illness or suffering is not only unjustified, but also violates the moral order presented by God. As a result, George should continue receiving medical treatment and care for the ALS until he dies a natural death. He should not consider euthanasia.

Question 6. Based on your worldview, what decision would you make if you were in George’s situation?

Based on my worldview as a Christian, I would not consider euthanasia and would proceed with treatment until my natural death. That is because my life as a human has dignity and value and is derived from God as my creator. As a steward of the life that God gave to me, I must uphold the sanctity of my life from my conception until my death. I do not look at suffering as an opportunity to prematurely end my life. Rather, I look at it as an opportunity to more completely entrust my life to God who lives me unconditionally and has a plan for my life (1 Peter 4:19, NIV). I can find ultimate hope and strength in Christ who conquered death in the midst of his suffering. As such, I should continue living and receiving medical care, and not consider euthanasia.

Conclusion

One must accept that Christianity as a religion has an impact on the health care process, especially for persons with terminal illness and who are facing unending suffering with no hope for cure until their death. In addition, one must acknowledge that Christianity has implications for the health care options available to terminally ill patients, especially with regards to euthanasia and the inherent value of human life. Given this awareness, medical personnel must be sensitive to the religious differences among their patients, and exhibit sensitivity when interacting with them. As the present case shows, human life has dignity for Christians and euthanasia may not really be an option for terminally ill Christians. A Case Study on Death and Dying: End of Life

Spirituality and religion have a big influence on people’s values, their belief system and general sense of well-being.  One’s religious beliefs will directly impact their actions and guide their choices.  This is often why so many patients will turn to religious guidance for coping during difficult times.  According to Daniel “most people, when faced with trauma and loss, will use some aspect of religious functioning to cope or will search for a way to understand the event based on cultural or religious assumptions” (2012, p.18).  Religion can have an impact on treatment choices, support systems, coping mechanisms along with the entire healing process.  “Religion is often distinguished from spirituality by its focus on behavioral manifestations of religious beliefs or values and social relationships among those united by a common faith” (Becker et al, 2015, p.105).  Strong beliefs and practices such as rituals, prayer and meditation are common findings among most of the world’s religions.  This is especially true with Christianity and Buddhism.  Nurses and healthcare providers should be aware of every patient’s spiritual and religious needs.  A spiritual assessment should be performed with every patient to provide comprehensive, holistic care and to provide needed interventions (Hermann, 2006).  This paper will focus on the worldviews and beliefs of Christianity and Buddhism as they relate to this particular case study.

Overview: End of Life Decisions

This case study is focused on George who is a successful attorney and active member of the community that he lives in.  He has a teenage son and he coaches for his basketball league.  He begins to notice some weakness in his muscles and difficulty with coordination.  When George goes to his Physician for an evaluation it is confirmed that he has the beginning symptoms of ALS or amyotrophic lateral sclerosis a degenerative disease that affects the nerve cells in the brain and spinal cord (Case Study, 2010).  ALS does not have a cure, it leads to complete muscle control loss and life expectancy is three to five years but could be longer.  Eventually George will be unable to perform basic tasks such as speaking, moving, eating and breathing (Case Study, 2010).  He will eventually be wheelchair and ventilator dependent.  George is overwhelmed by this diagnosis and believes this will be torture to live with.  He begins to consider voluntary euthanasia.

How each Religion Interprets George’s Malady and Suffering

            The worldviews of Christianity and Buddhism are very different.  Nurses should have some idea and knowledge of each religion so they will have an understanding of how each worldview could impact a patient’s outcome and healing process.  Christianity believes in God as the ultimate higher power, for Christians their reality revolves around the word of God.  God is the supreme, infinite power and the way of achieving eternal life (Hanser, 2016).  Buddhism views are different, their ultimate reality is in rebirth.  Samsara is the continuing cycle of birth and death, this will continue due to karma or doing good deeds (Wilkins, Mailoo, & Kularatne, 2015).

Christians have a strong sense in prayer and talking with God, who is their higher power.  During difficult times or life struggles, Christians find peace and healing using scripture and discussion with God (Hanser, 2016).  When looking at George’s condition from a Christian perspective, it is important for George to know that God has given us everything that we have.  We have been created in God’s image, God has given us life and God has a master plan for each of us (Meilaender, 2013).  God has developed every human with a purpose in life.  Our job here is to act according to God’s word, it is most important to live according to the Bible and the commandments.  These should guide us in what is right and wrong.  According to the Bible and the commandments, euthanasia is a sin and would be considered wrong.

If looking at George’s situation from a Buddhist worldview, it would be important for George to realize that this situation that George is dealing with is only temporary.  “All of these states are temporary, everything the human mind considers to be the self is illusionary and these features are rarely reincarnated” (Wilkins, Mailoo, & Kularatne, 2015, p. 295).  Buddhists believe that death and sickness are processes, life continues to change and they will encounter many things that can’t be avoided (Reichman, E., Gadson, S., Wongsarnpigoon, L., Gooneratne, N., & Wickremaratne, D.P., 2005).  The human life evolves, illness and disease are natural process that man must go through before finding inner peace.  For the Buddhist, there is a strong belief in the world that they live in and developing a nirvana, enlightenment or peace (Wilkins, Mailoo, & Kularatne, 2015).  They also believe in meditation as a way to concentrate and be calm.  A Buddhist believes that man does not control his fate.  He can avoid suffering by understanding his behavior and doing good deeds.  George needs to understand this.

How Each Religion Thinks About the Value of His Life as a Person and Value of Life with ALS

Christian religion views themselves as created in Gods image and therefore sees each human life as valuable.  God loves all humans equally and human beings are expected to love each other equally and are expected to treat each other kindly.  God forgives sins if you pray and ask him to.  For Christians sickness and suffering has to happen to develop eternal happiness and some believe it is what happens when you have sinned.  George needs to understand that ALS is God’s plan for him.

Buddhist believe that life is a process that continues to change, sickness and death are an important part of this process.  Doing good deeds will bring man karma which will lead to a rebirth as a god in heaven, bad deeds will bring a rebirth as an animal on earth (Wilkins, Mailoo, & Kularatne, 2015).  George needs to understand that according to the Buddhist religion illness is a part of the process and he will eventually have a rebirth.

Values and Considerations Each Religion Focus on in Deliberating about, Should George opt for Euthanasia

According to Christianity, euthanasia is a sin and therefore George should not consider this as an option for his illness ((Meilaender, 2013).  Euthanasia is considered wrong in the eyes of Christianity and is a sin against God.  Christianity would want George to turn to God in the form of prayer, church and community.  George should put his faith in God and find peace in knowing that God is the ultimate power and has a plan set for George’s life.

According to Buddhism euthanasia is also considered wrong.  Buddhists consider euthanasia to be suicide and this is considered bad karma (Wilkins, Mailoo, & Kularatne, 2015).  ).  The goal of the Buddhist is to have a clear, calm mind at the time of death.  Having a state a peace at the time of death will help a Buddhist achieve Nirvana.

Options that are Morally Justified for George

Options that would be justified for George would be prayer and meditation.  Talking to his higher power regarding his thoughts about his illness and his fears about how incapacitated he will become.  Spending time in church with a community of people that share the same religious beliefs and views.  Other options for George would be support groups, spending time with his family and finding all treatment options available.  Unfortunately for George it is likely that he will get very sick very fast.  George and his family do need to be presented with all the medical information necessary to be prepared for this.

My View

Part of providing holistic healthcare is allowing our patients to have autonomy.  Giving George autonomy would allow him to make his own decision in this matter.  “The American Medical Association’s Code acknowledges that the patient’s right of self-decision can be effectively exercised only if the patient possesses enough information to enable an informed choice” (Moulton & King, 2010, p. 87).  If George and his family have been given all the medical information necessary and George remains capable to make his own decisions, even if I don’t necessarily agree with his decision I feel he should be able to make this choice for himself.  Although, I am understanding in his point of view.  It would be devastating to be living a normal life and then suddenly require as much support as ALS would require for George.  Euthanasia is legal in some states and I believe this would have to be George’s decision to make.  If I were the one suffering from this type of illness, I would want the right to make this decision for myself as well.

Conclusion

Religion and spirituality have a very large impact in the healthcare process of our patients.  It is becoming more and more important as nurses to have knowledge of different cultures, religions and ethnicities. Religion will affect a patients treatment choices and healing process.  Performing a spiritual and religious assessment on every patient will help us provide the most comprehensive care possible and set up the best interventions.  If we do this we will ensure that we are doing our best to meet our patient’s needs.

George is a successful attorney in his mid-fifties. He is also a legal scholar, holding a teaching post at the local university law school in Oregon. George is also actively

involved in his teenage son’s basketball league, coaching regularly for their team. Recently, George has experienced muscle weakness and unresponsive muscle coordination. He was forced to seek medical attention after he fell and injured his hip. After an examination at the local hospital following his fall, the attending physician suspected that George may be showing early symptoms for amyotrophic lateral sclerosis (ALS), a degenerative disease affecting the nerve cells in the brain and spinal

cord. The week following the initial examination, further testing revealed a positive diagnosis of ALS. ALS is progressive and gradually causes motor neuron deterioration and muscle atrophy to the point of complete muscle control loss. There is currently

no cure for ALS, and the median life expectancy is between 3 and 4 years, though it is

not uncommon for some to live 10 or more years. The progressive muscle atrophy and deterioration of motor neurons leads to the loss of the ability to speak, move, eat,

and breathe. However, sight, touch, hearing, taste, and smell are not affected. Patients will be wheelchair bound and eventually need permanent ventilator support to

assist with breathing. George and his family are devastated by the diagnosis. George knows that treatment options only attempt to slow down the degeneration, but the symptoms will eventually come. He will eventually be wheelchair bound and be unable

to move, eat, speak, or even breathe on his own. In contemplating his future life with ALS, George begins to dread the prospect of losing his mobility and even speech. He

imagines his life in complete dependence upon others for basic everyday functions and perceives the possibility of eventually degenerating to the point at which he is a prisoner in his own body. Would he be willing to undergo such torture, such loss of his own dignity and power? George thus begins inquiring about the possibility of voluntary euthanasia.

The practice of health care providers at all levels brings you into contact with people from a variety of faiths. This calls for knowledge and understanding of a diversity of faith expressions; for the purpose of this course, the focus will be on the Christian worldview.

Based on “Case Study: End of Life Decisions,” the Christian worldview, and the worldview questions presented in the required topic study materials you will complete an ethical analysis of George’s situation and his decision from the perspective of the Christian worldview.

Provide a 1,500-2,000-word ethical analysis while answering the following questions:

1. How would George interpret his suffering in light of the Christian narrative, with an emphasis on the fallenness of the world?
2. How would George interpret his suffering in light of the Christian narrative, with an emphasis on the hope of resurrection?
3. As George contemplates life with amyotrophic lateral sclerosis (ALS), how would the Christian worldview inform his view about the value of his life as a person?
4. What sorts of values and considerations would the Christian worldview focus on in deliberating about whether or not George should opt for euthanasia?
5. Given the above, what options would be morally justified in the Christian worldview for George and why?
6. Based on your worldview, what decision would you make if you were in George’s situation?

Remember to support your responses with the topic study materials.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Lopes Write. Refer to the Lopes Write Technical Support articles for assistance. A Case Study on Death and Dying: End of Life