Last Update: Thursday, April 17, 2014
|Hospice Care, the Key to a Dignified Death|
|Written by Dr. David Lipschitz|
|Wednesday, 05 February 2014 23:29|
A patient that I had followed for many years carried a diagnosis of advanced Alzheimer's disease. Her family had agreed that she would not receive any aggressive care should she become acutely ill. However, when went into cardiac arrest at home, the family panicked and called an ambulance.
She was resuscitated and rushed to the nearest hospital, where she was admitted to an intensive care unit, placed on a respirator and given intravenous fluids. The environment was sterile, the family rarely saw a physician and was unaware of their mother's progress. After three days, a physician told them that they needed to pass a tube into her stomach to provide her with food. The family called me, not knowing what to do.
They hated the idea of their mother spending her remaining days alone in a sterile ICU with tubes in her body. She had made it clear that she did not want any extraordinary treatments merely to keep her alive. Her attending physician agreed that her condition was hopeless, and aggressive care fruitless.
She was in a coma, and a neurological evaluation indicated that recovery was not possible. The decision was made to place her on comfort care. The tube was not passed into her stomach, she was taken off the respirator and hospice care was contacted to help her die with dignity outside of the hospital. She was transferred to a private ward in the hospital, and two days later, admitted to an inpatient hospice unit.
The family stayed with her and prayed around her bed until she peacefully passed away. Most people hope to die quietly, with dignity, in their own home, surrounded by their loved ones. However, death most frequently occurs in a hospital or, worse still, an ICU.
The goal of our health care system is to prolong life at all costs; death is considered a failure, and health-care providers have little understanding or training in the ethical and loving care of the terminally ill. There is also concern that by not doing everything possible, they will open themselves up for criticism and even litigation. Families often view their loved one's terminal illness as an absolute nightmare.
Death is inevitable and a natural part of the cycle of life. However, the fear often associated with death and its unpredictable situations leave people hoping for a "short and sweet" one -- pain-free and dignified. "Please let it be quick" is a common refrain.
Unfortunately for many, death comes more slowly. Palliative and hospice care can be of great value for patients with no hope of recovery. People should have a living will, which implicitly describes their wishes. Making family members aware of what you want done alleviates the stress of last-minute decisionmaking.
Already I have told my family that if I have an incurable condition and cannot make decisions for myself, I do not want to be placed on machines, I do not want to be artificially fed, and, if my heart stops, I do not want to be resuscitated. I would prefer to be in my own home, and if I have only a few months to live, I wish to enter a hospice program.
To assist in the decision-making process, I have given my wife durable power of attorney, which allows her to make decisions if I am no longer able to make them for myself. Hospice helps patients die a good death and provides muchneeded support for the grieving family.
Care involves paying attention to the medical, social and spiritual needs of the entire family. Understanding the dying process provides invaluable assurance for the patient and family and facilitates an ability to cope with the ordeal. Hospice care is very proactive, aiming at assuring comfort. It is possible to be pain-free, to be at peace and not to suffer.
Families can stay close to and connected to their dying loved one. Those last few days or months can be very precious. Entering a hospice usually means acceptance that death is imminent, and admissions to the hospital are limited exclusively to treat conditions that may cause unnecessary suffering. Remember a good death means a better life. Dr. David Lipschitz is the author of the book “Breaking the Rules of Aging.” To find out more about Dr. David Lipschitz visit www.drdavidhealth.com.