‘Deluxe Deaths’ or dignified dying?
Help people 'Live' till they leave
'Death. Dying. Loss and Care'- Social experiences or Medical Events? This was the Theme of the 3rd International Conference on Public Health and Palliattive Care held in the beautiful place of Limerick west of Dublin (banks of the river Shannon) which I attended, and this essay is few thoughts I gleaned from the conference
Death is the final physical exit of a human being from earth. The Speciality of Palliative Medicine affirms life and regards dying as normal. It neither hastens nor postpones dying.
Palliative medicine focuses on symptom control ensuring for those whose predicted life span is short not only a good quality of life but also a good quality of death
We enter ‘life at birth and leave life at death’. So it behoves us to give the same care to those who leave life, the care we gave to them when they entered life.
Economic liberalization and a corporate culture resulted in spawning of ‘Five star Hospitals’ . This has resulted in the ‘Medicalization of suffering and the Institutionalization of death’.
The British Medical Journal in a landmark article in 2003, defined as to what constitutes a ‘good death’. In several incurable conditions where realistic hope of cure or a return to normalcy does not exist, the best place for the patient to be cared for is his or her home. Dying well is to die well cared for at home.
‘Intensive Care’ often morphs into an industry draining the family of all their life’s assets. Whereas ‘Euthanasia’ is the administration of medicines with an intent to ‘kill’, letting die is a different approach altogether. The former is to be condemned and is legal in Belgium and Holland and in the states of Washington, Oregon, Montana and Vermont.
Palliative Care is ‘Low tech and high touch’.Touch is therapeutic, reassuring and comforting. While called to see a patient in an ICU I remembered that taking the pulse was an excuse to touch the patient ,and when I attempted so, I was told that pulse was on ‘that wall’. Technology to a great extent makes us recede from the patient. Unless mandatory patients should not be tethered by wires to machines that beep and squeak, lonely without the family.
The best place for death to happen is where the patient belongs , and that is the home environment surrounded by the familiar, the family, the furniture,photographs, routines and habits. Most symptoms can be controlled and the relevance of home care cannot be overemphasized.
Good communication skills are vital. The family needs to be convinced that unlike in mainstream acute care medical practice which is like mathematics, a problem to be solved, several incurable illnesses have to be regarded as an experience to be lived through.
‘Cure sometimes, relief often but comfort always’ is an age old aphorism.Death is inevitable and as far as possible we need to value ethics of beneficence,, non-malfeasance, patient autonomy and justice.
Both quality of life and quality of death are important parameters to be monitored and addressed
Justice is balancing ‘risk and reward’ , ‘benefit and burden’ of a particular means of treatment plan and chance and statistics should not be the arbiter. The virtues of Commonsense, Compassion and Cleverness are needed. The right mix of the former two can make this world a better place to live.
We need to see that death, dying loss and care as ‘social experiences’ rather than medical events.
Death is not a defeat or failure in several instances and let us strive to give a ‘good death’ to help families in distress.
‘Death is not extinguishing the light , but the turning down of the lamp because the dawn has come’ -R Tagore.