S5 L1 Palliative care - A good death Flashcards Preview

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Flashcards in S5 L1 Palliative care - A good death Deck (21)
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1
Q

What are the key objectives of palliative care?

A
  • Affirm life but regard dying as a normal process
  • Provide relief from pain and other distressing symptoms
  • Neither hasten or postpone death
  • Integrate psychological and spiritual aspects into mainstream patient care
  • Provide support to enable patients to live actively as possible until death
  • Offer support to the family during the patient’s illness and in their bereavement
2
Q

How does the WHO define palliative care?

A

An approach the improves the quality of life of individuals and their families facing problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, pychocosocial and spiritual

3
Q

Is there such thing as a good death?

A
  • No one wants to die so how can it be a good thing
  • Improve the QoL of people that are going to die - reaching the end of their life
  • Part of caring is helping people have a good death
4
Q

How do you facilitate a good death in the dying?

A
  • Remember that suffering is experience by people, NOT bodies
  • More than symptom control
  • Care involves the physical, psychological, emotional, social and spiritual aspects → Holistic approach
5
Q

Why is death so difficult for practitioners and patient?

A
  • Own death is unimaginable

- No one believes they’re going to die!

6
Q

What factors make a good death difficult?

A
  • Truthfulness (honest/open) with patients
  • Enabling informed consent
  • Allowing time to prepare
  • Avoiding isolation
  • Overcoming a wall of silence
  • Maintaining hope by accompanying them on the journey (it is so important what you say to patients)
7
Q

What is the dilemma around dying?

A

How do you diagnose when someone is dying?

At which point can you say they are dying

8
Q

What is futility?

A

Where curative treatment is continued where there is no prospect of success- prolongation of life
- enabling someone to have a good death is not a failure, continuing treatment that will not work can prevent a patient from having a good death

9
Q

Why is holistic care important?

A

Need to treat the patient as a whole
Symptoms control is important but other non-drug aspects of life are also important
People can experience pain associated with other things - spiritual reasons, family reasons, social reasons
Patients may need to confess/sort things out so that they can have a good death
Resolving conflicts can help release pain

10
Q

What is anticipatory grief?

A
Psychological process that a patient (and relative) go through when they are dying 
- Anger
- Denial 
- Bargaining 
- Depression 
- Acceptance (or resignation) 
Can go through them in any order 
Before the patient dies
11
Q

How can you facilitate a good death?

A
  • Avoid medicalisation and prolonging the dying process
  • Avoid the situation of ‘medical captivity’ of being a frightened patient, enable their release from captivity
  • An agreed care plan is required avoiding ‘managed states’ (ReSPECT form/DNAR)
  • Ability to die one’s own death
  • Adequate symptoms control
12
Q

Who is the informal carer and why are they important?

A
  • Family, loved one, friends, carers etc.
  • Look after the patient the most
  • A lot of support and input is required for these patients
  • Opportunities for respite care maybe important
  • Grief before or after death
  • Ensure they do not feel guilty that they have ‘failed’ their loved one in any way - reassure they did their best
13
Q

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A

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14
Q

What if the patient is suffering?

A

Suffer = inadequate palliative care
Require urgent review by a specialist
Euthanasia is not a prevision of good dying but a failure of good communication and palliative care

15
Q

What is the doctrine of double effect?

A

Some medication help to relieved pain and suffering can then bring forward death
Foreseen but unintended consequence

16
Q

What are the principles of a good death?

A
  • To be warned when death is coming and learn what can be expected
  • To be abele to retain control of what happens
  • To be able to afford dignity and privacy
  • To have control over pain relief and other symptoms control
  • To have choice and control over where death occurs )(at home or elsewhere)
  • To have access to information and expertise of whatever kind is necessary
  • To have access to any spiritual or emotional support required
  • To have access to hospice care
  • To have control over who is present and who shares the end
  • Able to write an advance directives which ensure wishes are respected
  • Have time to say goodbye, and control over other aspects of timing
  • To be able to leave when it is time to go, and not to have life prolonged pointlessly
17
Q

What are hospices?

A
  • Style of care, rather than a place
  • Includes team of people - Drs, Nurses, Social workers, therapists, counsellors, trained volunteers
  • For the patient and their families
    Offers
    → Primary care → medical interventions to help alleviate and manage a patients symptoms
    → Spiritual and emotional support
    → Assistance with practical matters such as insurance
    → Offer respite care- carers a break
    → Bereavement care
18
Q

Define euthanasia?

A

The painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma
Active→ deliberate use of lethal substance to end someone’s life
Passive→ withholding of life support and life sustaining treatments
Voluntary→ performed with patient full and informed consent
Non voluntary→ patient is unconscious or incapable of making a decision - someone decided on patients behalf
(assisted suicide- similar but undertaken by the patients themselves but Dr may have prescribed the treatment)

19
Q

What is the law around euthanasia in the UK?

A

Illegal → considered murder or manslaughter

20
Q

What are the ethical principles around euthanasia?

A

Arguments for and against
For
→ More humane than allowing someone to suffer continuous pain
→ Dying with dignity is important
→ Human right
→ Autonomy
→ QoL can only be assessed by individual themself
Against
→ Difficult to regulate
→ People vulnerable to abuse - could be used as murder in some cases - family member act in ‘best interest’
→ Goes against Hippocratic Oath - Do no harm
→ Determining mental capacity and competence can be difficult
→ Patients may feel like a burden on family so do it for the wrong reasons - pressurised to end their own life
→ People might regret decision- made at bad moment in life
→ Culture, religions and societies - Affront the sanctity of life

21
Q

What are ReSPECT forms?

A

Recommended Summary Plan for Emergency Care and Treatment

  • Creates personalised recommendations for person’s clinical care and treatment in a future emergency in which they are unable to make or express choices
  • Usually created in people who have complex health needs, people nearing end of life, risk of sudden deterioration or cardiac arrest
  • Non-legally binding
  • Reviewed and adapted if circumstances change
  • Created through conversations between a person, their families, and their health and care professionals to understand what matters to them and what is realistic in terms of care and treatment
  • Allows people to have a good death