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End of Life Care Essay

Info: 966 words (4 pages) Nursing Essay
Published: 22nd Apr 2021

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Tagged: palliative care

Decisions for End-of-Life Care

End of life decision making can be an aspect of concern that is both complex and challenging for the aged population. Accordingly, the elderly deal with diverse ailments that may impactful on the rational decision making. Most importantly, aged individuals have to grapple with the futility disputes in handling essential decisions on the Medicare process. Hence, a shift in the decision making has become imperative to determine who should make decisions when issues surrounding Medicare at the end of life emerges.

Who should make decisions when questions arise about Medicare at the end of life?

In the contemporary environment, the use of advanced directive has become apparent in dealing with decisions surrounding end of life. Specifically, among the individuals who are incapacitated, the directive provides the procedures adopted to deal with the Medicare issues for a patient (Lennon-Dearing et al., 2015). Working in the healthcare sector however has presented vital challenges in adopting the directive to handle the ageing population. The directive deals with individuals in a coma, brain dead or basically unable to make decisions to establish the decision making process (Koenig, Lim & Tsai, 2015). As such, through the directive, communication of the general wishes prevails which leads to the development of debates about its effectiveness (Holt, 2018). At the core of the directive is the need to encompass a specific individual to deal with the preferences of the elderly surrounding Medicare at the end of life. Okie (2014) acknowledges that the acknowledgement of a surrogate individual to make decisions about Medicare at the end of life is a noteworthy option for the elderly. Surrogate decision maker should encompass people of close ties.

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 Accordingly, surrogates as the decision maker should be focused on conforming to the patient’s welfare. Focusing on ensuring that the wishes are upheld within the reasonable platform is critical considering the significant financial implications of Medicare at the end of life. Most importantly, it is critical to grant the surrogate a higher authority in dealing with elderly (Lennon-Dearing et al., 2015). In some instances, the elderly may exude ailments such as dementia which may cloud decision making. For an effective decision making platform, the surrogate should determine the Medicare process in instances that aggressive intervention is required (William et al., 2014). A step by step approach to encompass surrogate decision makers is applicable and based on dealing with significant issues that may emerge in the Medicare process. Among the dimensions of concern include counseling of the surrogates in instances that the decisions may affect the life of the patient.

 Smith (2014) accepts that the surrogates make decision for an elderly patient based on substituted judgment. Accordingly, the decision criteria rely on the good understanding of the patient wishes. Thereby, the reliance on the surrogate in future should be the platform for improving the Medicare process. Accepting the complexity of the decision making initiatives in the near future will depend on the surrogates who bring forth a renewed dimension of dealing with elderly healthcare (William et al., 2014). Despite the complexities surrounding the values, beliefs and preferences of the elderly that the surrogate ought to encompass in decision making, their role should not be under-estimated.


 The potential for increased ageing population is an issue of concern that has become a facet of concern. Therefore, to enhance the decision making, it is advisable to use surrogate individuals who will be the substitutes for the elderly. Through the surrogates, decisions about end of life Medicare can be undertaken effectively. In instances that the elderly patients deal with ailments such as dementia, Alzheimer’s or terminal diseases, the role of the surrogates is acceptable in enhancing decision making.


  • Holt, G. R. (2018). Making difficult ethical decisions in patient care during natural disasters and other mass casualty events. Otolaryngology-Head and Neck Surgery, 139(2), 181-186.
  • Koenig, K. L., Lim, H. C. S., & Tsai, S. H. (2015). Crisis standard of care: refocusing healthcare goals during catastrophic disasters and emergencies. Journal of Experimental & Clinical Medicine, 3(4), 159-165.
  • Lennon-Dearing, R., Lowry, L. W., Ross, C. W., & Dyer, A. R. (2015). An interprofessional course in bioethics: Training for real-world dilemmas. Journal of interprofessional care, 23(6), 574-585.
  • Okie, S. (2014). Dr. Pou and the hurricane—Implications for patient care during disasters. New England Journal of Medicine, 358(1), 1-5.
  • Smith, G. P. (2014). Law and Bioethics—Intersections along the Mortal Coil. Indiana Journal of Global Legal Studies, 20(1), 505-520.
  • William Joseph Buckley Ph.D., M. A., Sulmasy, D. P., Aaron Mackler Ph.D., M. A., & Aziz Sachedina Ph.D., M. A. (2014). Ethics of palliative sedation and medical disasters: four traditions advance public consensus on three issues. Ethics & Medicine, 28(1), 35.


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