Case Study: Alice Kautz
A few weeks after Donâ€™s mother died, he met with a nurse and a care coordinator who worked in the independent living facility where his parents lived during their last years. He told them both, â€œWhen nursing instructors like me dream of death with dignity, we dream of a death like Aliceâ€™s.â€Alice Kautz was 89 years old when she died 10 months before her husband, Harry, died. Alice was fiercely independent all her life. She and Harry decided to leave the condominium where they had lived for over 20 years and move into an independent living facility after Alice found Harry â€œdownâ€ and had to call 911 twice in a month. A few weeks after Alice and Harry celebrated 50 years of marriage, Alice was diagnosed with breast cancer. Because she had some difficulty with problem solving, Alice knew about the tumor in her breast for months before she finally decided to seek treatment. When Alice had a mastectomy performed, the oncologist discovered that the breast cancer had metastasized to her liver. Alice lived for several months after the discovery of the metastases. Because she had several months to prepare prior to her heath, Alice was able to make the arrangements she desired, which helped her die with dignity.Alice and Harry were both enrolled in hospice, and they had weekly visits by an RN during the early summer months prior to Aliceâ€™s death. They made changes to their wills and powers of attorney during that summer and made sure that all their affairs were in order. They had saved money and lived frugally, and so they were financially secure. Their oldest son became their power of attorney and paid all their bills during the last months of Aliceâ€™s life.Harry had dementia, and even though he was independent in his basic ADLs, he was not able to problem solve or live independently. As Aliceâ€™s endurance declined, the staff at the independent living facility made arrangements for personal care assistants (PCAs) to provide around-the-clock care for both Alice and Harry. The PCAs ensured that both Harry and Alice ate every meal, their laundry was done, and their personal needs were met. The care provided by the PCAs allowed Alice and Harry to live together until Alice died.Alice and Harryâ€™s three children traveled from Colorado, New York, and Italy to Arizona in order to visit Alice in the months before her death and to say good-bye. Alice was cognitively intact until her last days, and she had very little pain from the cancer. Aliceâ€™s daughter was with her during the last two weeks before her death, and she returned to Italy the day before Alice died. Her family likes to think that Alice waited until her daughter arrived safely at home before dying. Her daughter made arrangements for all of Aliceâ€™s children to talk to Alice one last time during the week before her death. Alice was regularly visited by members of the hospice team and her long-time minister and friend. Everyone involved in her care said that she â€œwas at peace with dyingâ€ for several months prior to her death.On the night Alice died, the PCA called the care coordinator, who came up to her room. The care coordinator later told me that she will always treasure the way Harry said good-bye to Alice after she had died, taking off her wedding ring to keep.
1. An individual possessing mental capacity has the right to make his or her decisions
regarding health care and end-of-life preferences. How would Aliceâ€™s health care
professionals have determined her decision -making capacity?
2. What are two types of advance directives available for individuals determined not to have
the decision-making capacity?
3. The PCAs honored Aliceâ€™s dignity by making provisions for her physical comfort during her
final days. What are some other ways in which health care personnel could have enhanced
her dignity during this time?
Explore the website www.completingalife.msu/edu/audioon/intro.html to find information on
the important issues to address when assisting individuals to plan for their final hours of life. To
answer questions 4-7, go to the following specific sections of the website: last hours, goals, loss
of control, health care, and family decisions.
4. Using resources on the website, what are some additional arrangements and decisions
that health care professionals could have assisted Alice and her family to identify and
discuss regarding her desires for completing her life?
Hospice is a philosophy of palliative care that uses a team of professionals to support the
physical, emotional, and spiritual needs of an individual during end-of-life care.
5. What professionals are involved in a typical hospice team and how do they ensure the
dignity of their client(s)?
6. Aliceâ€™s children all had the opportunity to visit with her and talk with her on the phone to
say good-bye before her death. What are some other means of communication that can be
used by an individual who wishes a final contact with those who may be unable to visit or
talk on the phone?
7. Refer to â€œPlanning for the Last Hours and After.â€ What are some questions that an
individual should consider if he or she wishes to plan for the last hours of life?
Alice only had minimal cognitive impairment and was not demented. However, those with
dementia also need nurses who will help them die with dignity. A new type of advance directive
was created several years ago to allow for life planning while living with Alzheimerâ€™s disease and
dementia. This document was the first of its kind focused on these specific challenges. With a
purpose similar to a living will, the Alzhe8imerâ€™s and dementia directive aims to have a personâ€™s
intentions known when the person isnâ€™t in a place to speak for himself or herself.
8. Use the link www.deathwithdignity.org/2013/04/16/alzheimers-dis… to distinguish the difference of a traditional advance directive compare to the Alzheimerâ€™s directive.
Suggested ResourcesDastidar, J. G., & Odden, A. (2011). How do I determine if my patient has decision-making capacity? The Hospitalist. Retrieved from http://www.the-hospitalist.org/details/article/130…
How_Do_I_Determine_if_My_Patient_has_Decision-Making_Capacity.htmlGatto, M. A., & Zwicker, D. (2006). Want to know more: Palliative care. Hartford Institute for Geriatric Nursing. Retrieved from http://consultgerirn.org/topics/palliative_care/