A Good Death

Question 1

Who initiated the hospice movement in 1967?

Answer 1

Dame Cicely Saunders - she created it so no one suffered during death

Question 2

What is the philosophy of care from hospice movement created by Dame Cicily Saunders?

Answer 2

Involves science of symptom control and communication
Faciliate ‘life until they die’

Question 3

What type of care is required for the dying?

Answer 3

Hollistic - suffering is an experience by persons
Care involves physical, psychological, emotional, social and spiritual care (total care)

Question 4

Why is death so difficult for practictioners and patients?

Answer 4

Own death is unimaginable
No one believes their own death
We are all convinced of our own immortality

Question 5

Factors which make facilitating a good death difficult

Answer 5

Death is taboo - rare for people to see death, become medicalised
But death is natural

Question 6

6 ways to achieve a good death

Answer 6

• Truthfullness - honest and open with patients
• Enabling informed consent
• Allowing time to prepare
• Avoiding isolation
• Overcoming wall of silence - communicate
• Maintain hope by accompanying them on the journey

Question 7

What should you never say to a patient?

Answer 7

There is nothing more that can be done for you - NEVER say this - there is always pallative care, options

Question 8

Another challenge of facilitating a good death>?

Answer 8

At what point does the transition occur from cure to palliation - how do we define ‘dying’

Question 9

What is futility?

Answer 9

Where curative treatment is continued despite no prospect of success - just prolonging life

Question 10

What do we do when we decide that change from curing to palliative care?

Answer 10

Get informed consent - care when cure is no longer possible
Enable the patient to accept their death is part of healing process
Prepare loved ones and patient

Question 11

Who was Dr Elizabeth Kubler Ross?

Answer 11

Psychiatrist who wrote the pyschological stages of dying, anticipatory grief:
* Anger
* Denial
* Bargaining
* Depression
* Acceptance (or resignation?)

Question 12

Importance of personal reflection and review of ones end of life care

Answer 12

Patients cannot come back and tell us if they had a good death
It is important for us to reflect and learn lots from them at the time

Question 13

What can we do as doctors for someone dying?

Answer 13

talk to patients - be with them through that journey of death
Spend time making them feel at ease and listened to

Question 14

What can be the cause of sometimes unmanageable pain?

Answer 14

Spiritual pain - if someone has unresolved conflict in life this can present as physical pain that is poorly managed by drugs
Encourage letting go, resolving, saying goodbye and closure

Question 15

Is there a right place to die?

Answer 15

People may have preferences but it matters less where we die vs how we die
A good death is more important

Question 16

5 points of a good dying

Answer 16

• Avoid medicalisation - and thus prolonging dying process
• Avoid situation of medical captivity - a frightened patient, enable their release
• An agreed care plan - ReSPECT forms/DNAR
• Die ones own death - be able to die in the way you want to
• Adequate symptom control

Question 17

What can be offered to informal cares during a good death?

Answer 17

A lot of support
Opportunities for respite - a break from caring
Grief before and after death support
Ensure they do not feel guilty that they have failed their loved one in any way

Question 18

What is suffering during death?

Answer 18

Inadequate palliative care - needs review of specialist
If people start wanting euthanasia usually a sign of failure of communication and palliative care

Question 19

Principles of a good death - learn for exam

Answer 19

• to be warned of death coming and learn what can be expected
• Retain control of what happens
• Dignity and privacy
• Control over pain relief and symptom control
• Choice and control over where death occurs
• Access to information and expertise of any kind
• Access to spiritual or emotional support (eg priest)
• Access to hospice care
• Control over who is present and who shares the end
• Write advanced directives which ensure wishes are respected
• Have time to say goodbye and control over timing
• To be able to leave when it is time to go and not have life prolonged pointlessly

Question 20

What is double doctrine effect?

Answer 20

Where something is done with good intentions but can cause bad outcomes

eg giving morphine is done for symptom control and to ease suffering but it can cause respiratory depression and death