In today's day and age, the options for end of life care are countless and include nursing homes, at home hospice, live-in aides or visiting nurses and family support to name just a few. Most approaches regarding end of life care are often similar and include palliative care, living wills, aid-in-dying, “full code” and “DNR” in hospitals. Some people might argue that with more choices, deciding on an option can become overwhelming for either the patient or the family. The current quality of life and end of life care options are obviously better now than in early American history.
In the mid 1900’s, end of life care for the rich was very different than it was for the impoverished. Those with money had the means to hire attendants to care for them and their needs as opposed to people who were simply elderly, ailing or feeble. If a person were poor, they had to rely on their family for care or they would end up living life as a beggar or waiting to die in an almshouse, which is a house built by charitable people or organizations for poor people to live in. The residents in these homes were mostly drug and alcohol addicts, the mentally insane or unstable, other homeless people, and criminals. Also, if a person was sick and declining and came from an impoverished background, then death was almost certain. Leonhardt, David. (2006, September 27) wrote, “For most of human history, the average lifespan was considerably less than 50 years. It began to rise markedly in the 19th century, hitting 49 in the United States in 1900, and then took off in the 20th century.” The website Senior Living.org. (2019, July 25) states “There are many factors that impact the life expectancy of people and individuals. War, disease, genetics, diet, lifestyle, gender, and health are a few of those.” This does not include sudden death as with heart attacks and stroke, fatal accidents, and incurable diseases, dying is highly uncommon before someone loses their mobility, intellectual know-how, and sensation. While tragic in today’s world, dying at the age of 60 is considered young, and might have been the happy ending for a person from the past who accepted his or her death as an end to homelessness, poverty or illness.
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Although the rich had more opportunity to obtain resources, they would still be lucky to survive if they became sick. Antibiotics and what is now known as modern medicine had not yet matured and money could only buy temporary relief but not offer a cure for the illness. Bellis, Mary. (2020, February 11) stated “Penicillin is one of the earliest discovered and most widely used antibiotic agents. While Sir Alexander Fleming is credited with its discovery, it was French medical student Ernest Duchesne who first took note of the bacteria in 1896. Fleming's more famous observations would not be made until more than two decades later.”
The past also contained folk stories and fairy tales that often portrayed the elderly and frail in disturbing conditions. D. L. Ashliman. (2020, March 29) Edited and translated folk tales such as “Beauty and the Beast”, the “old hag” is a homeless woman who is ugly and impoverished. In the “Water of Life”, the youngest son and hero of the story is assisted by a handicapped dwarf, who is also unsightly and poverty stricken. One of the seven evils released from “Pandora’s Box” was old age. Just the nature of being elderly was comparable to being diseased with the only wish of having a swift yet, peaceful death.
Moving forward, sometimes churches, religion and health care would come together, one such entity is the American Red Cross and some think of this type of place as a “sanctuary”. In the past, churches or religious installations did not offer a general sanctuary to just any sick or aged person for end of life care. Only privileged, wealthy and prominent members of society had access to basic care at these facilities, even though the less fortunate had the same religious beliefs. These facilities resembled what we now know as nursing homes and were run by different types of religious groups. To obtain access to these facilities, even the rich would need someone to vouch for their good character and they would need proof of their wealth.
Since then, there have been drastic changes to the quality of life in the elderly. According to the Centers for Disease Control and Prevention (2016, March 11) “In 2016, approximately 15,600 nursing homes were in operation in the United States.” Through the use of insurance or self pay, both demographics, rich or poor have the same opportunity to obtain access to affordable healthcare. Also during the 1900’s, pensions and Social Security arrived as people were living longer and needed a means to support themself after retirement. Now, instead of anticipating their death, they were faced with a series of lifestyle choices. “How can I fully enjoy my golden years?” forms the opinion that the change in end of life decisions are now a golden prospect.
Modern advances in technology have paved the way for our lives to be prolonged for an uncertain period of time. Although most people will most likely pass away before they reach 100 years old, their lifetime can easily stretch across three or four decades. Americans today are trying to stay active and independent, living well by eating healthier and seeking early medical intervention in order to live longer.
In earlier years, cases of strokes, cancer, and paralysis led to the formation of pressure ulcers and oftentimes the affected limbs were amputated. Many of these cases were considered “dead cases” if they were rendered comatose or partially functional. Is wasting away in a vegitative or minimally functioning state considered living? According to the National Cancer Institute (2012, May 10) “The period at the end of life is different for each person. Their signs and symptoms vary as their illness continues, and each person has unique needs.” and “Patients and their family members often want to know how long a person who has cancer will live but that is a hard question to answer”. Recently, scientists are researching and using theories based on stem cells for the regeneration of healthy tissue to cure or reverse damage from disease such as cancer.
Today’s end of life cases are somewhat complicated because medical staff can not be certain that vegetative states or paralytic lifestyles will resolve due to modern medical intervention. Sometimes these conditions cannot be avoided or reversed even to a small degree. A physician tries to help these individuals by practicing beneficence and non-malfeasance however, once a person has declined to a worsened state, the question then becomes whether or not continuing curative care would be moral and ethical. There is still the question that comes up with no clear answer. Is it ethical to administer treatment when there is obviously no hope of a cure just to prolong life? Palliative care and hospices advocate for living out one’s final months or days comfortably; which usually means pain management until death, while others say that with life there is hope and curative treatment should continue. According to the website Helpguide.org (2020, April 15) “Hospice is typically an option for patients whose life expectancy is six months or less, and involves palliative care (pain and symptom relief) to enable your loved one to live their final days with the highest quality of life possible. Hospice care can be provided onsite at some hospitals, nursing homes, and other health care facilities, although in most cases hospice is provided in the patient’s own home.” Unfortunately, modern medicine still depends mainly on helping people treat the symptoms of an illness, instead of curing it. Most hospitals in the United States have a policy that once care has been started it cannot be withheld. This is also true with life support, it cannot be discontinued once started as it leads to certain death. This is a decision that will be made by the family.There are many resolutions to end of life care, some creative, and some suspect of ethics and morality. For example, in some hospitals, medical staff observe what is called a “slow code”, where rather than trying to immediately save a patient; they prolong the time it takes to offer aid and any extended care can be avoided. This is done with the belief that they are ending one's suffering. In the end, the outcome is literally all up to the individuals caring for you.
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