Palliative care is the advanced care of patients who are terminally ill and are closer at their lives’ end. Symptom management, pain management, and the provision of social, spiritual and psychological support are carefully given by the practitioner, or by the one who is giving care to the sick person. Palliative care achieves to meet the goal of giving the best quality of life that they can give to the patient and to the patient’s family. Palliative care aims to impart to the patients that dying is a normal process that people undergo once in their lives. Practitioner offers support to patients to be able to live actively until the time of their death. And they aim to provide a system that will help the family cope during the patients’ illness and in their bereavement ("Palliative Care Explained ").
The Sea Inside in a Nurse’s perspective
The movie talks about the life of a quadriplegic. The main character Mr. Ramon Sampedro was a ship mechanic in his younger days. After the tragedy Ramon became bedridden because he restrains himself from being imprisoned by a wheelchair; he believed that being imprisoned by a wheelchair will be just imprisoning him with the scraps of his past. He was a man who had his own perspective and depicted life as his own, and that he had the right to end his life. He, Ramon Sampedro, was the only Spaniard who had requested for Euthanasia (Blaser, Jan. 5, 2005).
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Among the people who have taken care of Ramon was Manuela his sister-in-law, his father, his older brother Jose, and Gene. His legal counsel Julia gave him sympathy, she listened to Ramon’s sentiments and Ramon listened to her sentiments as well. This is because they share the same perspective that they wanted to “die with dignity.”
The movie provided a general assessment of Palliative care. Each of Ramon’s family members gave justification to the concepts of Palliative care in general. Although there were some concepts of palliative care that were not given justification because Ramon doesn’t have his own nurse to do the Nursing care plan. Nursing care plan includes assessment; subjective and objective, nursing diagnosis, planning, interventions and evaluation. In Ramon’s case, assessment should have been done regularly. Subjective data includes information directly from the patient’s feelings while objective datas are those measured and observed by the physicians. After initial assesment, a problem list should be made consisting possible reasons that affects the patient’s well being qlike family problems, medical diagnosis and many others.
Diagnosis comes when the collected datas relates to a certain illness or disease. In planning of interventions to be used, the preparation should be specific, attainable, measureable, realistic and time-bound. Intervension are the methods to be used in order to meet the goals in planning. It includes what medications to be applied, possible surgeries, etc. Every intervension has a rationale like why a nursing action should be done and what is its basis. And lastly, evaluation are written reports about the improvement of patient or the contrary. In evaluation it is stated whether the goals in planing is met, partially met, or not met (By Jane Urie).
As shown in the movie, Ramon didn’t want to be loved because he believes that a person undergoing his illness would be creating misery to the person that loves him. This implies that Ramon is having psychological and emotional distress and should have been assessed by a physician to be able to bring him back to life. However, in Julia’s case it was shown that she had undergone observations and treatments when she developed a disease called Cadasil due to her series of strokes, therefore palliative care was well addressed.
Pain control for instance was well established in the movie because there was a scene when Ramon was given tranquilizer to stabilize him. Although there was an error in giving him the medication, because if the medication was given by a nurse the nurse should have only given him an exact dosage of the tranquilizer, just one tablet not three. As a nurse exact dosage or amount of medicine should only be given to a patient to prevent overdose and complications.
The conflict of the story is about the ethical and moral issues of Euthanasia. Today, euthanasia has been legalized. It was being applied in cases of hopelessness in the recovery of the patient. “Eu” means good and “thanator” means death, euthanasia therefore means good death or mercy killing. There are different classifications euthanasia: voluntary, non-voluntary, involuntary, assisted, euthanasia by action, and euthanasia by omission. In voluntary, the patient was the one who requested his death. In non-voluntary, the person who has been killed made no request and gave no consent. In involuntary, the patientmade an expressed wish to the contrary.
Assisted Euthanasia is perform with the assistance of the physician or the relatives of the patient. Euthanasia by action makes use of lethal injection while euthanasia by omission is the process wherein the patient is no longer being provided with his needs like food, water, medication, etc. The reasons why it is being practiced are to diminish unbearable pain, the right to commit suicide, and the belief that people should not be forced to stay alive ("Voluntary Euthanasia " Apr 18, 1996).
Ramon wanted to die. He said “Well, I want to die because I feel that a life in this condition has no dignity.” In the case of Ramon, who is quadriplegic, refusing to live shows that he was experiencing fatigue, depression, anxiety, and Dyspnea (maybe due yo lack of ventillation). Ramon believed that dying is an unevitable part of a man’s life and it is just normal to die. Due to his own beliefs Ramon passed a petition about legalizing suicide or the right to die.
A paraplegic priest visited him to discourage his intention of suicide. His brother, Jose, also agrees with the priest and the church’s belief that suicide is immoral, that only God has the right to decide whether an individual should live or die. They believe that God has His reasons and purpose why a person still lives. It was Him wo gave you life, so it is also his decision to take it back. Thereof, this situation talks about morality ("The Sea Inside,"). As for the health providers, it also brings a great controversy whether to practice Euthanasia or not. Health providers were trained to cure not to kill. And assisting a suicide contradicts the profession with the duty of “do no harm”.
From the movie itself, cultural considerations and individual considerations was well established. There was a clear observation that the people around Ramon did not want to consider his attempt of killing himself. Ramon as an individual had also been given consideration; although his beliefs of death was unjust they still did not oppose to him because they considered his own perceptions and did not want to oppress his rights as an individual. For a nurse, I would consider his beliefs because it was his right but I would not help him accomplish his death.
The tragic part of the story is that his family was well oriented and they have accepted that death is coming to Ramon. There was a scene in the movie wherein his father said “what’s worse having your son die on you, is the fact that he wanted to”. It only shows that he had accepted the death of his child but he had not accepted the fact that his son wanted to die.
Ramon’s family had actually given him quality care and unconditional love. Although these were really not enough especially in the case of Ramon. From a nurse’s point of view, the care that the family could have been improved if there is a plan of care that was established. Ramon had supposedly had a life that is worth living. His family loved him and took care of him, he had a book published, two women were linked to him and the sympathy of the nation was on him but he refused all these and exchanged it to death. He had exchanged all the beautiful things he had in life because he justified his life as his.
For years Ramon had actually internalized that death is in his hands and that he had the right to end his life. Generally speaking, Ramon had actually lived a life that is not worth living because he restraints himself from having so. As a nurse, I could have implied to Ramon that his life is worth living and that he need not to worry that he will be a big burden to his family and to the people he loved while he is living. It is not a nurse’s job to kill but rather to nurture.
- Blaser, A. (Jan. 5, 2005). Bizzaro Breathing Lessons [Electronic Version] from http://www.ragged-edge-mag.com/reviews/blaserseainside.html.
- By Jane Urie, B., MRPharmS, Helen Fielding, MSc, MRPharmS, Dorothy McArthur, MSc, MRPharmS, Moira Kinnear, MSc, MRPharmS, Steve Hudson, MPharm, FRPharmS, and Marie Fallon, MD, FRCP. Palliative care [Electronic Version] from http://www.pjonline.com/Editorial/20001021/special_feature/palliative_care_603-614.html.
- Palliative Care Explained [Electronic Version] from http://www.ncpc.org.uk/palliative_care.html.
- The Sea Inside [Electronic Version] from http://www.boxofficeprophets.com/tickermaster/listing.cfm?TMID=1556.
- Voluntary Euthanasia (Apr 18, 1996).
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