>When should palliative care begin?
Palliative care is planned to meet not only physical needs but also the psychological, social, cultural, emotional and spiritual needs of each person and family. Palliative care services are helpful not only when a person is approaching death but also at earlier stages in the illness. If we understand palliative care to be aimed at reducing pain and suffering and using a holistic approach to the patient and their life, palliative care should be available from the beginning of treatment, especially for those recognized as not eligible for curative therapy and should be combined with treatments aimed at reducing or curing the illness.10 However, palliative care tends to be the main focus of care when it is believed that a cure for the illness is no longer possible.
When: Discontinuance of treatment and palliative care
Two important values in palliative care are neither prolonging nor hastening death, and to relieving suffering while enabling people to live as actively and meaningfully as possible until they die. Palliative care is often incorrectly linked with the right to die movement despite the fact that since its beginnings, palliative care has always strongly opposed euthanasia, assisted suicide and measures to hasten death.
The decision to end ‘treatment’ is complicated from the perspectives of people with disabilities because the social aspects of disability come into play in effecting people’s state of mind, and can be expressed as existential suffering on the part of the patient.
Because of a lack of knowledge about various impairments among medical workers a person with a disability in a medical crisis may not be given enough time to respond to treatment and will discontinue it. This is likely to happen when medical personnel do not fully understand the impact of that disability on recovery.
Because of the complexity of suffering at the end of life, which is often expressed by the patients as hopelessness and an inability to find meaning, the medical community is increasingly likely to resort to "quick fixes" like terminal sedation. Terminal sedation is a growing practice that needs to be carefully monitored so that it does not become more widely accepted. John Seely explains that,
Terminal sedation has to do with giving drugs…that sedate a patient to the point that they can no longer eat or drink; where the express outcome is to relieve suffering but the subtext of that is that this will lead to hastening death.11
This trend needs to be resisted in the field of palliative care. The challenge is to work with patients to help them find meaning at the end of their life. The disability community has a lot of experience and knowledge to offer palliative care workers in terms of coping with changes and increasing impairment at the end of life.
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