Life Span Issues and End-of-Life Decision Making

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Consider the experience of a teenager with acute lymphoma that is unresponsive to any treatment, with a prognosis of death in the next two weeks, being approached by her staff nurse about where she would like to spend the rest of her days. On the other hand, imagine a healthy widower of ninety-four years with several children and numerous grandchildren and great-grandchildren, approached by his physician about end-of-life choices should an accident or unexpected illness occur, robbing him of his capacity to make decisions at that time. Finally, ponder the 40 year old female diagnosed with level three breast cancer, recommended treatment of weekly chemotherapy, whose prognosis is unknown. The experiences of these individuals vary dramatically, as likely will their responses to end-of-life choices. A large part of the difference in responses relates to each individual’s developmental “place” in the span of life. Life span development is multi-dimensional, with cognitive, social, emotional, spiritual, physical, and behavioral elements, multi-directional, with increasing and decreasing capacities, based on context, subject to environmental and cultural changes, and ranging across the entire life, from infancy to the oldest old in scope. Erikson (1997) provided a noteworthy contribution to the life span perspective by explaining development in terms of psychosocial stages into late adulthood, rather than previous theorists who ignored development beyond adolescence, with each new stage presenting an opportunity to reach healthier development if “tasks” are resolved properly. The stage in which an individual is in his or her life largely influences how challenges are perceived and approached. The purpose of this chapter is to look at how life span issues affect the end-of-life decisions we make. We will begin with a discussion of theoretical perspectives of decision making, move to literature review of end-of-life decisions at different life stages and with special populations, and conclude with implications for caregivers.


Contribution to Book: Handbook of Thanatology