Termination Process

Paper Summary:

In this article, the writer discusses that when there are patients receiving treatments or interventions that keep them alive, one may face the decision of whether to discontinue treatment. The writer offers the example of an adult male patient at the HIV Treatment Center on dialysis for acute renal failure and mechanical ventilation for respiratory failure. The writer notes that in this case the total parenteral nutrition (TPN) treatments are no longer of benefit, even though the patient's family wants them continued. The writer maintains that if life expectancy can be prolonged with additional chemotherapy, it may be reasonable to give TPN to allow the patient to enjoy that benefit. However, the writer concludes that in the case where additional chemotherapy offers no substantial increase in quantity or quality of life, TPN could become another burden for the patient without any meaningful benefit, and ought to be withheld.

Outline:
Transference and Counter transference
Futility Judgments
Debating Cardiopulmonary Arrest and Resuscitation

From the Paper:

"Transference and countertransference are both normal phenomena that may arise during the course of the therapeutic relationship. Transference is the tendency on the part of the patient to "transfer" past feelings, conflicts, and attitudes into situations, circumstances and present relationships. According to psychoanalytic theory, transference evolves from unresolved or unsatisfactory childhood experiences in relationships with parents or other important figures. From a behavioral orientation, patients may have developed habit-forming patterns in how they relate and interact with others. These habits involve development of attitudes and ideas based on the learning and retention of information from past relationships. The habits learned from past relationships may create behavioral and thought patterns in subsequent relationships, even though the actions and attitudes may be inappropriate for the current relationship. As caregivers have frequent contact with patients, the potential for caregivers to be objects of transference is significant."

Sample of Sources Used:

• Braddock, C.H. (1998) Termination of life-sustaining treatment. University of Washington School of Medicine. Seattle: Department of Medical History and Ethics. Retrieved 3/12/07 from http://depts.washington.edu/bioethx/topics/termlife.html.
• Frequently asked questions. (2007). The World Federation of Right to Die Societies. Retrieved from http://www.worldrtd.net/faqs/qna/?id=8.
• Guru, V., Verbeek, P.R. and Morrison, L.J. (1999). Response of paramedics to terminally ill patients with cardiac arrest: an ethical dilemma. CMAJ. 61 Nov; 161(10).
• Hilz, L.M. (1999). Psychology Terms: Transference and countertransference. Kathy's Mental Health Review. Riverside, CA: Mental Health. Retrieved from http://www.toddlertime.com/mh/terms/countertransference-transference-3.htm.
• Strayhorn, J..M. (1982). .Foundations of Clinical Psychiatry. Chicago: Yearbook.

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