Bridge Over Troubled Waters: End-of-Life (EOL) Decisions, A Qualitative Case Study

This case study investigated the psychological and emotional experiences of nine health care professionals who attended a Five Wishes seminar, designed to acquaint participants with thinking holistically about death. All the self-selected participants had experienced the death of a loved one and indicated they were able to discuss death issues. Data collection included interviews, observations, physical artifacts, and the Five Wishes documents. Content analysis was the central technique used to identify themes. Findings indicated participants attended the EOL seminar to share information with their colleagues and patients; the information also interested them personally. However, facing death and making EOL care decisions were difficult for the participants. The EOL seminars educated them regarding some of the mysteries and problems of EOL care and offered them some solutions and insights both professionally and personally. This study has implications for educators and health care professionals: 1) EOL decisions are facilitated by the social support of group settings. 2) Reluctance about facing death can be reduced by comprehensive, lifelong education beginning in the early childhood years and culminating with holistic advanced directives such as the Five Wishes. Key Words: Advanced Directives, Living Wills, Death, Five Wishes, Holistic, End Of Life (EOL), Terminal Disease, Values, Social Support Introduction The purpose of this exploratory, qualitative collective case study was to discover the psychological and emotional experiences of self-selected seminar participants after attending a seminar about End-of-Life (EOL) care decisions and living wills. Background For decades physicians rarely informed their patients of a terminal diagnosis, depriving them of the possibility of making informed decisions regarding management of their treatment (Hill & Shirley, 1992). There were few curative therapies available for life-threatening illnesses (Golub, 1994). The nurse's role was to make the terminally ill patients comfortable as death approached. Prior to the early 1980's, physicians and the general public often felt that caring for patients meant withholding painful news of a terminal condition (Hill & Shirley, 1992). This stance was contrary to the position held by many nurses (Olson, 1997). Remarkable developments in pharmacology and medical technology during the 1940's and 1950's brought many changes (Golub, 1994). The physician's role was to control symptoms of a dying patient, thereby becoming the "conqueror" of disease and death (Cassedy, 1991). Veath (1989) declared, "Death, as never before is looked upon as evil, and we are mobilizing technology in an all-out war against it. If not death itself at least certain types of death are beginning to be seen as conquerable" (p. 91). Dozer and Addison (1992), in their investigation of resident physicians' practices with dying patients, noted that biomedical technology provided a "credo of saving patients' lives at all costs" (p. 540). Decision-making often was not an option because physicians routinely failed to share a terminal diagnosis with their cancer patients (Hill & Shirley, 1992). However, Annas (1989) indicated that during the 1960s and 1970s several court cases in which patients successfully sued their physicians for failure to disclose information about their conditions and treatment options reinforced the legal principle of informed consent. Since 1980, the rights of competent patients to refuse medical treatment became an option (Hill & Shirley, 1992). Physician paternalism is less acceptable to patients and families today. Patients have opportunities to seek options and choices if they are aware of the situation. Society is attentive to reason-based decisions (Goldstein & Hogarth, 1997). However, Larson and Tobin (2000) reported that the structure of the medical care system discourages meaningful EOL discussions. …