September , 2013
THE MEDICAL ETHICS ALLIANCE, would like to offer the following statement as a response to the Leadership Alliance for the Care of Dying People.
C CONSIDER the situation calmly, with care and compassion.
Is the person imminently dying?
Where do they want to be – home or hospital?
How secure is the diagnosis?
Have all reversible aspects been considered?
Have legal issues been considered?
What is your intention for this patient?
Is it time to change gear and to stop striving to keep the patient alive?
No one should be asked to consent to be sedated except for medical reasons such as severe distress or lack of sleep, nor be subject to dehydration.
Is the patient able to give informed consent to any action that is proposed?
O is for Other.
Consider other approaches i.e. active treatment of chest infection, heart failure.UTI etc.
Consider other diagnoses.
N is for Nutrition and Hydration.
Is it possible to feed the patient?
S is for SPIRITUAL CARE
Simple services cheer souls. Dying patients may want to see a priest. See Spiritual Guidelines in the Dying: published by Catholic Bishops.
I is for Information
Give the patient information if they seek it, but do so gently. Be honest but gentle. It is so important for patients generally to realise the reality of the situation and attend to their spiritual needs, but it may take a considerable time or some to reach this moment. The “Five Stages of Grief” have to be worked through.
Minimise potential problems and assure them that help will be available if needed.
Do not overstep the bounds of your competence in such discussions. Consult and get professional help when necessary.
Few patients wish to know their proximity to death. Some cope by denying death until it can no longer be ignored. Be realistic – but leave room for hope, and always try to breath hope into impossible situations in one way or another.
D is for DYING
Discus any issues that arise, but do not force discussions about death on your patients. Help them to live with dignity until they die.
Try to ensure that family and friends they wish to see are contacted in time. It is always helpful to remember the “Five stages of Grief” hypothesis introduced by Elizabeth Kublar – Ross ( from her book “On Death and Dying” ) that patients have to pass through before accepting death.
E is for Euthanasia
Which should remain unlawful. Resist pressure to assist a suicide or risk 14 years in jail
If you have serious concerns about a death alert the police and report the death to the Coroner.
R is for RELATIVES
Are they coping? Have they said their good byes?
Beware of those who wish the patient dead.
The bad death of a loved one can destroy lives and cause post – traumatic stress.
Some relatives will need bereavement counselling.