Who Makes The Final Decision? Essay

1849 words - 7 pages

In 1969, Elisabeth Kübler-Ross opened a dialogue of debate about death and dying. She accomplished this with her ground breaking book On Death and Dying. In 1993, another physician by the name of Sherwin Nuland, continued the dialogue with his popular book How We Die- Reflections on Life’s Final Chapter. A comparison of chapter one, On the Fear of Death, from Kübler-Ross’s book, and chapter seven, Accidents, Suicide, and Euthanasia, from Nuland’s book, shows that both Kübler-Ross and Nuland argue for control over the circumstances surrounding a patient’s death. However, while Kübler-Ross advocates for strong patient control, Nuland emphasizes the need for physician and society control.
The sub-title of Elisabeth Kübler-Ross’ book describes her audience as doctors, nurses, clergy and the family of dying patients. Because of her target audience the book is written on a more emotional level, citing examples of both positive and negative death experiences. There are no detailed descriptions of what happens to the body as it dies, just discussions of how the dying person might feel and how they might want to experience their last moments of life. Sherwin Nuland takes a much more scientific approach with his book How We Die. In chapter seven, Accidents, Suicide and Euthanasia, Nuland describes in great detail the pathophysiology of how a person dies from sepsis and pulmonary infection. His book is targeted more towards the health care professional who is familiar with technical discussions of the pathophysiology of a certain disease process. The choice of target audience by each author correlates to their discussions regarding who controls the death experience. Kübler-Ross argues for patient input and control and so she targets not only doctors and nurses, but also clergy and the family of the dying person. Nuland believes doctors are best suited to make decisions about end of life care and he therefore targets the healthcare provider, especially the physician.
“When a patient is severely ill, he is often treated like a person with no right to an opinion. It is often someone else who makes the decision if and when and where a patient should be hospitalized” (Kübler-Ross 22). Throughout her chapter on the fear of death, Kübler-Ross describes how death has become lonely and impersonal. She points out that while we have advanced in our scientific methods of medicine, we have somehow lost track of the patient and how he might feel. The patient who is dying has feelings, wishes and opinions and these must be given priority by the healthcare profession. Kübler-Ross points out that we often see death as a failure to succeed. We focus on the machines and the medicine and we forget there is a person behind it all who should have some say in how they end this life on earth. The dying patient may have a request regarding his end of life care, but all too often their desires are not listened to since any discussion regarding death causes...

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