End of life care

Hospice care

Duties of a doctor
- to cure (only now and then accomplished)
- to relief suffering : when cure is not possible
degenerative diseases : cardiovascular etc, Ca,
diabetes etc (often successful)
- to comfort (always beneficial)
 Hospice care
Ca, AIDS, heart patient, Alzheimer,
renal failure
Empathy : tender loving care
Life saving treatment negatif
Symptom treatment positif 
pain
management
Pain management : morfin
nerve blockage
relaxation techniques
acupuncture
massage
Objectives hospice care : comfort
relief of suffering
optimation organ
function
quality of life
 To support :

physiological
emotional of hospice care nursing staff
should be supported by
social
spiritual need.
psychological
social
pastoral staff
terapeutical
volunteer
 Death

Health professionals are not yet prepared

to give assistance to dying patients.
Death education for health providers 
competence to give pleasant and
effectivesupport to critically ill patients
and their family.
 Death education for community :
death education prepares members of
the community to obtain theright
attitude towards the event of death and
to manage problems caused by
bereavement, accept death peacefully
not with revolt
What bothers the critical patients is
suffering caused
by pain parting with beloved ones
and uncertainity
about the journey to eternity
 Ethical issues in the treatment of
critically ill patients :

- does the patients need ordinary or extra

ordinary care standard care should be given
to all patients but extra ordinary care is optimal

- what is the objective of the treatment ?

a) to kill the patient ?
b) to alleviate pain ?
 - Differences between killing and letting die
a) killing is an action that causes death
b) letting die is the neglect of an action
to prevent death
- not starting live supporting treatment
- cessation of life supportingtreatment
- Is euthanasia acceptable
a) physician assisted suicide
b) voluntary euthanasia
 Characteristics of death

Traditional
- loss of consciousness
- no heart beat persistent
- no efforts of breathing
Contemporary characteristics of death
- brain death : a) brainstem death
b) permanent unconsciousness
permanent vegetative state