Table of Contents
Improving Ethical Treatment
of Chronically Ill Patients
Amy O. Calvin, Ph.D., assistant professor, School of Nursing
Amy O. Calvin, Ph.D.
No one wants to think about how they would want life to end. But for chronically ill patients, the painful decision must be made to allow resuscitation or to die when the time comes. Research by Amy O. Calvin, Ph.D., has helped patients and health professionals interact with each other to ease end-of-life care.
“I had the opportunity to care for many patients with terminal or irreversible conditions as a nurse in the emergency department and the adult intensive care unit,” Calvin said. Inspired by three patients suffering from kidney failure, Calvin became particularly interested in how chronically ill patients make decisions about end-of-life treatment.
Calvin’s experience in the hospital fostered an interest in ethical treatment of chronically ill patients. “I pursued graduate study to gain knowledge of concepts related to health care ethics and to acquire the necessary tools to help me improve seriously ill patients’ situations,” she said.
Her graduate research explored how patients make difficult decisions regarding life-prolonging medical treatment, including the decision to allow or forgo resuscitation. Through Calvin’s study of patients with kidney failure, she developed a Theory of Personal Preservation, which evaluates patients’ attitudes towards responsibility and risk-taking to provide an explanation of their decisions to forgo or accept endof- life treatment.
Following completion of her graduate work, Calvin collaborated with Lillian Eriksen, D.S.N., to develop the Advance Care Planning Readiness Instrument. Using her Theory of Personal Preservation and with the assistance of a panel of end-of-life care experts, Calvin designed this readiness assessment tool with data obtained from a small sample of hemodialysis inpatients at St. Luke’s Episcopal Hospital.
The tool aids health care providers in judging a patient’s readiness to allow life to end. “When health care providers know if a patient is ready to forgo end-of-life treatment, a thorough discussion of the patient’s end-of-life treatment may ensue and the patient may then formulate advance directives requesting to allow death,” Calvin said.
This instrument also may help health care providers avoid placing undue pressure on a patient who is not ready to discuss these options. “When health care providers use the Advance Care Planning Readiness Instrument to learn that a patient is not ready to forgo end-of-life treatment, a patient’s values may be respected without discussion of endof- life treatment wishes, and the patient may be reassessed at a later time,” she said.
“Quantifying patient readiness to forgo end-oflife treatment may encourage health care providers to become more insightful, understanding and supportive toward patients,” Calvin said. “Use of the Advance Care Planning Readiness Instrument may promote an easier, more integrated, comprehensive approach to the sensitive topic of advance care planning.”
Calvin’s future research proposes to test the Advance Care Planning Readiness Instrument in a larger hemodialysis patient population.