1. It is very important for patient to express preference about
health care at end of life. Family should accept patient's decision. Patient
had undergone long period of intense pain, suffer and mental stress. In
particular the terminal stage is severe than other stages. Therefore it
is necessary to make the terminal stage short and less painful for patient.
2. For instance, I had taken care of a diabetic patient when
I was a nursing student. She had received the right toes amputation operation
once because her high blood sugar made these toes gangrenous and necrotic.
She didn't have the good blood sugar control. Unfortunately, her new wound
got the virus infection and gangrene again. Therefore the doctor decided
to perform the second amputation operation from the right leg ankle to
3. Before she underwent the operation , she very expected her disease
was under control. by medical treatment - Whereas, after the second amputation,
she had became upset and sad because the body image was changed and her
condition was getting progressively worse. Final1y, she lost confidence.
She worried about the enormous medical bills' burden to her family.
4. After two months, she received the third amputation from the right
knee joint to upper thigh because the virus infection were still out of
control. In addition, the wound tissues were getting necrotic, intensive
pain, and had an odd smell from the wound continually. She was disappointment
and depress completeJy because she knew that her disease was incurable.
Beside, she understood that she was going to die in the severe infection
sooner or later. It was impossible to perform the amputation again.
5. Finally, she asked to sign a form refuse medical treatment. After
a few days, her life was terminative. In my view, if we make a right health
care decision with the advance directive, that will decrease the family
burden and would alleviated the intense pain in our terminal stage.