No matter what age, a patient’s bill of rights dictates that they deserve to be treated with dignity and have their wishes respected. However, end-of-life care presents specific problems for both children and adults. Age often determines the quality of end-of-life care. For patients to receive the best care possible, family, friends, and healthcare providers should act in the best interests of the patient.
End-of-life care presents many difficult decisions. An advance directive can help to prevent confusion in fulfilling an individual’s final wishes. With proper documentation, adults are most often able to direct their care and spend their final days according to their own wishes, even if they become mentally incapacitated. However, the children and the elderly often face unique challenges which may hinder their personal choices about end-of-life care.
Children who are terminally ill are subject to the wishes of their parents or legal guardians. If the parents or guardians have a different mindset, then the children’s final wishes may be ignored. Because they are minors, children may not be regarded as completely capable of making such important decisions. Parents can interfere with their children’s care by trying to implement painful and futile life-sustaining treatments. Lack of financial resources may limit the ability for children to receive palliative care at the end of their lives. Insurance is more likely to cover the medical bills of adults. When children are terminally ill, the illness is often unexpected and less likely to be compensated by insurance. Parents may also be in denial of the severity of their child’s illness and postpone options for end-of-life care.
However, because parents or legal guardians are such an intricate part in their children’s medical direction, their feelings must be taken into consideration. A study in 2006 by Meyer, E., Ritholz, M., Burns, J., & Truog, R., stated that the six most important factors for end-of-life care in children were honest and complete information, accessible staff, good communication and care coordination, emotional expression and support by staff, preservation of the parent-child relationship, and faith. While these factors are important in terminally ill patients of all ages, the preservation of the parent-child relationship is unique to children (Davies, Sehring, Partridge, Cooper, Hughes, Philip, Amidi-Nouri, & Kramer, 2008.
Older adults have barriers to their end-of-life care as well. Even though their wishes for end-of-life care may be more likely to be respected than that of children, if there is a question of their competency, their decisions about their healthcare may be ignored. If older adults have dementia, then they may be regarded as unable to make decisions as well. Older adults are more likely to spend their final days in a hospice; Medicare may not cover all the costs for palliative care, leaving older adults dependent on either relatives or the government. Even though older adults may want to remain in their home environment, the nature of their illness or the demands of their families may cause them to end their lives in intensive care units or sedated in a nursing home (Curtis, Nielson, Treece, Downey, Dotolo, Shannon, Back, & Rubenfeld, 2011). This is especially likely if they have dementia and their families are unable to provide adequate care. If there are advance directives in place, then they are more likely to have their wishes granted. Another problem faced by older individuals is that they may be less likely to receive life-saving procedures due to perceived futility or lack of financial resources: these procedures may be more likely to be administered to children or younger adults.
By putting the needs of the patient first, healthcare providers can ensure that the patient’s wishes for end-of-life care are respected. Each age group has their challenges which must be overcome; though children may not be able to sign advance directives and are subject to the demands of their parents or legal guardians. When individuals are regarded as unable to make their own decisions, they are often forced to undergo or be denied treatments and procedures despite their final wishes. If communication is kept open and patients, regardless of their age, participate as much as possible, their end-of-life care can be as close to their wishes as possible.
Curtis, J., Nielson, E., Treece, P., Downey, L., Dotolo, D., Shannon, S., Back, A., & Rubenfeld, G. (2011). Effect of a quality-improvement intervention on end-of-life care in the intensive care unit. American Journal of Respiratory and Critical Care Medicine, 183(3), 348-355. Retrieved from http://www.atsjournals.org/doi/full/10.1164/rccm.201006-1004OC
Davies, B., Sehring, S., Partridge, J., Cooper, B., Hughes, A., Philip, J., Amidi-Nouri, A., & Kramer, R. (2008). Barriers to palliative care for children: Perceptions of pediatric health care providers. PEDIATRICS, 121(2), 282-288. Retrieved from http://www.pediatricsdigest.mobi/content/121/2/282.full
Meyer, E., Ritholz, M., Burns, J., & Truog, R. (2006). Improving the quality of end-of-life care in the pediatric intensive care unit: Parents’ priorities and recommendations. PEDIATRICS, 117(3), 649-657. Retrieved from http://www.pediatricsdigest.mobi/content/117/3/649.full