Friday, 19 January 2007

A Humane Death- the Role of the Palliative Care Team

In the UK and USA there are specialist teams that work both in the Community and Hospital referred to as the Palliative Care team.

These doctors and nurses deal soley with palliation and providing a painless, anxiety-controlled and humane death for terminally ill patients.

Terminally ill patients not only include those with cancer, but also those patients suffering with end-stage conditions such as COPD, Heart failure, Liver Disease and Chronically progressive debilitating neurological conditions.

They will review patients on a general ward and provide advice on stopping treatments that are not helping and commencing medications to help a whole host of different symptoms that the terminally ill may suffer such as pain, anxiety, constipation, ascites, respiratory secretions, etc...

Their role in the hospital setting is very important because when they are called in, a patient's treatment can be significantly altered from one of full active treatment to one which palliates, and the medical staff are then able to provide a different, more private and dignified standard of care, such as treatment in a side-room, less disturbance by medical personnel, less painful blood tests etc..

The palliative care team also run the Community Hospice care and in the UK, these small units are a cross between a hotel and hospital providing comfortable and relaxing surroundings for treatment. Not all patients are admitted in terminal stages; some are admitted for temporary treatments such as drainage of ascites (paracentesis) , respite care or even just to adjust pain relief under under a controlled environment.

In the UK, it is sometimes more important to provide the patient with a decent, humane and painless death rather than continuing to press on with aggressive pro-active medical therapy which is clearly futile. This sometimes involves stopping antibiotics, stopping drugs that are there to reduce risk factors of cardiovascular disease, such as stopping some blood pressure drugs, anti-platelets agents, statins as these may be unnecessary at their terminal stage of illness.

One could look at this type of medicine as 'giving up', but I do not see it as this, as usually the patient's condition reaches a point when it is clear that it is unfortunately not going to improve and therefore, it is better to alter therapy with the progression of their illness.

As far as I am aware, the Palliative Care services in Japan are not as developed as those in UK or America, and I truly believe that such services would make a wealth of difference to patients and it would also help patient's families to accept the inevitability and futility and also to enable them to make plans for the short-term future and allow for acceptance thereby making grieving easier to take.

Patients have a right to continue living but also the right to not have intolerable medical treatment, and as doctors, we must listen to our patients about what they want, rather than what we think is best for them. We are not special people with God-like powers and rules. We too are human and we must treat people equally as we ourselves would like to be treated.

The 'take home message' is Listen to, Respect and be Humane to your patients and do what is right for your patients at all times.

If you have any views on today's blog then please write me :) !!

No comments: