- The Experiences of Suffering in Palliative Care Patients - ehospice
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- Being Mindful, Easing Suffering: Reflections on Palliative Care
- 2004 - Being mindful, easing suffering reflections on palliative care - Johns.pdf
In research, literature on suffering and quality of life is scarce when compared to literature on diseases and drugs. These gaps drive us to conduct a series of research to gain a deeper understanding of suffering in palliative care. Based on a study, an existential-experiential model of suffering was developed. This model can serve as a complement to the existing biopsychosocial-spiritual model in understanding and managing suffering. The existential-experiential model of suffering was conceptualized from thematic analysis. This model is represented by six types of existential suffering and four types of experiential suffering as followed:.
From the study, in the assessment of suffering, an approximate minute patient-centred interview is adequate in diagnosing salient suffering of most palliative care patients. Next, based on this existential-experiential model, a mechanism-based two dimensional approach can be used in the management of the relevant suffering. Examples are given below:.
The Experiences of Suffering in Palliative Care Patients - ehospice
Furthermore, the separation of existential and experiential suffering enables a flexible approach in the management of suffering in terminal illness. If the existential realities cannot be rectified, then more effort should be put on addressing the experiential dimension, such as intensive symptom control for sensory suffering and various psycho-spiritual supports for the emotional, cognitive and spiritual reactions triggered by the sensory perceptions.
In simple terms, when the external realities in life are unchangeable, we can still change how we react to these realities. Because of this, we have developed two mindfulness-based approaches that may help in the management of palliative care suffering by targeting these reactions, as followed:. As a non-reactive present-moment practice, I have a strong belief that incorporating mindfulness in the management of suffering in palliative care can be of great help. Furthermore, the authors claim that patients who are not terminal are being admitted to hospice, some chronically ill with conditions such as Alzheimer's and brain damage, only to die from dehydration.
They maintain that withholding nutrition and hydration is "often done with the intention that the patient die" and that "physicians who seek to continue providing food and fluids are often pressured not to do so. What evidence is proffered to support these charges? The evidence is anecdotal. At one point in the account, the author wrote: "As the employees of father's assisted living facility came by on their regular rounds, I told them that my father was being killed.
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They acknowledged that I was right. They were very aware of what was happening. What are we to make of the claims in these articles? First, it is quite possible, if not likely, that what is described does occur. Some physicians probably do employ opioids or palliative sedation, or the withdrawal of nutrition and hydration, to bring about the death of some of their patients.
Being Mindful, Easing Suffering: Reflections on Palliative Care
However, it is far from clear whether these are isolated incidents or relatively frequent practices. It is irresponsible in so many ways to infer the latter without solid evidence, and that would be very difficult to come by. It is also irresponsible to generalize from one or several instances to postulate a widespread problem. The fact that there may be some abuse by some physicians does not vitiate all of palliative care and hospice. Nor does it mean that all of palliative care and hospice have been infiltrated by a culture of death.
Second, these practices can occur outside the context of palliative care and hospice. Not all patients who receive opioids or who opt for palliative sedation are, in fact, receiving palliative or hospice care. Hence, to associate and limit the abuse of these practices, assuming they do occur, with hospice and palliative care is misleading at best.
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But more seriously, it is extremely harmful to all the efforts that have been and are being made to have palliative care programs in place in acute and long-term care facilities. Immense progress has been made over the years, but there is still a long way to go. The charges by these authors, the seeds of doubt they have planted, can not only undermine further progress in advancing palliative care and hospice, but also undermine the confidence of patients, families and physicians in the benefits of palliative care and a willingness to make use of it.
While attempting to call attention to abuses in end-of-life care, the authors have dealt a blow to the best hope for improved end-of-life care that currently exists. In trying to save the lives of some dying patients, they have contributed to undermining good care for tens of thousands of other dying persons.
2004 - Being mindful, easing suffering reflections on palliative care - Johns.pdf
John Paul II mentioned palliative care in his encyclical Evangelium Vitae , in the context of his discussion of decisions to forgo disproportionate medical treatments. This statement, as the one from Evangelium Vitae , is followed by a brief discussion of the licit use of pain killers and the need to avoid the administration of "massive doses of a sedative for the purpose of causing death.
Pope Benedict XVI endorsed palliative care on several occasions. In his message for the 15th World Day of the Sick, for example, Benedict stated:. In , while visiting the Hospice Foundation of Rome, Pope Benedict again referred to palliative care:. Fourth, in light of these accusations, Catholic health care, especially palliative care and hospice programs in Catholic health care facilities, needs to be vigilant against abusive practices that counter a Catholic approach to end-of-life care.
Such practices undermine a Catholic understanding of palliative care and hospice and could end up undermining the immense progress that has been made to date in supporting and assisting those with chronic and terminal illnesses.
Toward this end, Catholic health care organizations should be clear about the Catholic tradition regarding the use of opioids, a proper understanding of what is and is not a morally licit use of palliative sedation and when it is morally permissible to withhold or withdraw medically administered nutrition and hydration. Vigilance also is necessary when partnering with or joining coalitions and organizations devoted to promoting good end-of-life care.
There is too much at stake here for Catholic health care not to be vigilant and not to take pre-emptive measures. As the Ethical and Religious Directives for Catholic Health Care Services so eloquently and aptly state: "What is hardest to face is the process of dying itself, especially the dependency, the helplessness, and the pain that so often accompany terminal illness.
One of the primary purposes of medicine in caring for the dying is the relief of pain and the suffering caused by it. Effective management of pain in all its forms is critical in the appropriate care of the dying. Log in Forgot Password?
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- The Experiences of Suffering in Palliative Care Patients - ehospice?
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