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From early childhood, it becomes clear to every person that their time on this planet is limited, and that they will have to die one day. This realization, however, in most cases, does not manifest itself in everyday life because most people find it much more comfortable to disregard that fact and live their lives as though that moment will never come.
It can be a question for a debate as to where this attitude comes from; however, when thinking about it more thoroughly, one has to conclude that this attitude is wrong because we cannot just ignore a fact that shapes the human condition on the fundamental level.
Only when they become aware that they are ill and that there is no cure for their illness, do people accept this fact and try to spend the rest of their time in a best possible way. In recent years, in addition to the research in curative medicine, some scientists have decided that trying to find ways to eliminate the symptoms without curing the illness is worth the effort.
This branch of medicine is called hospice or palliative medicine. The aim of the people who are engaged in hospice is to establish efficient methods that could help patients who cannot be cured to spend the final days of their life in comfort by providing them with medical, psychological, spiritual and all other kinds of guidance (Methia, 2010).
First off, given the fact that the science of medicine is rapidly advancing, we are becoming able to cure more and more illnesses, it is certain that human life expectancy is going to increase. On the other hand, it is also true that a completely effective cure for deadly diseases, such as cancer, will not be found very soon.
Also, many scientists predict that in the absence of other causes, the percentage of deaths from cancer will be increasing constantly (Cancer Facts & Figures, 2012, p. 7). This places an obligation on the scientists and the society as a whole to try to find ways of improving the lives of terminally ill patients.
For the abovementioned reason, various hospice centers are being established all over the world. These centers are run either by the government within such institutions as hospitals or nursing homes, or they belong to the private sector. Each of the centers typically has a team that consists of one physician, one psychologist, one nurse and if it is religious based there is also a priest (What is Hospice Care, 2003, p. 57).
Medical help at hospice clinics has several aims. First, the chosen doctor has an obligation to explain to the patient his condition so that the patient could have an understanding of his or her situation and be able to make necessary plans accordingly. Secondly, of course, the main goal of the medical part of the team is to reduce or eliminate the symptoms of the disease. A lot of terminal diseases cause a lot of pain in terminal stages so the physician has to prescribe an adequate pain therapy.
Also, each type of condition and therapy demands a different diet so the physician has to be able to give advice or even prescribe the entire program of nutrition for a patient. In addition, if it is possible, the goal of the medical team should also be to give their best to prolong the patients life and make it as pleasant as possible. In some centers, this also includes alternative medicine such as chiropractic and many other alternative medical approaches (Gib, 2011).
It is clear that dying patients can experience psychological problems, and for that reason, almost all hospice care teams include a psychologist. The psychologist has to have specialized knowledge in the psychological conditions that are likely to occur in terminally ill patients. The main goal of this component of the therapy is to give advice and support for the patient as long as it is necessary. In addition, psychologist might also prescribe medications that can improve the patients psychological well-being (Methia, 2011).
Human beings are deeply social, and they have a strong need to be accepted in a group. Unfortunately, as it has been said, our culture still holds death as a taboo, and for that reason, people do not want to have a dying person in their environment. All of this makes a social challenge that dying people face perhaps the most difficult one.
Therefore, in addition to a psychologist, who can also be helpful in this domain, hospice teams often have a social worker whose specialty is to address this very important issue. The goal of the social worker is to take care of social aspects of the patients life. He or she has to establish good contacts with the patients family and friends.
Furthermore, if a center takes care of many people, the social worker can design activities such as group therapy in order that the patients see that they are not alone and that many people share their condition. This can be, perhaps, the most beneficial aspect of hospice, because during those activities it is not rare that the patients to make friendships, which although they are unfortunately not very long lasting, make the last days of the patients lives much happier (Methia, 2011).
These centers address one more aspect of the patients well-being which is related to economy. Today, we are living in a society where almost everything is susceptible to the market, and really necessary things tend to have huge prices. It is a sad thought that terminally ill patients are one of the groups which is the most affected by this rule. The prices of everything from special medication to the necessary medical equipment impose great economic pressure on the patients.
These centers are in most cases able to provide all the necessary services with reduced price, and they also provide many other ways to reduce the financial burden of patients and their families. The most important thing is that once a patient is received in an institution of this type, he or she can forget about all those economic difficulties and think about the things that are really important (Plocher & Metzger, 2001, p. 222).
Unfortunately, as a result of the recent economic crisis, many people are not able to provide this type of care for themselves or their loved ones. However, many government programs, like Medicare or Medicaid in the United States or similar programs in other countries of the world, are designed to cover the expenses of such care.
In the United States, people who are diagnosed with a terminal condition, and their physician made a prognosis that they have less than six months to live can choose one of a large number of licensed hospice centers and their insurance will cover the expenses (Medicare hospice benefits, 2010, p. 43).
One of the most difficult problems related to hospice is to decide when curative medicine loses its purpose, and it is time to switch to palliative medicine or hospice. Most of the people have heard of cases when a person was about to die, but they suddenly almost mysteriously recovered.
One thing should be very clear to both the doctors and the patients together with their families, which is that no doctor can tell with absolute certainty that a condition will ultimately lead to death and that there is absolutely no chance of recovery. What they can do is present the patient and the family with the estimated probability of recovery together with the problems that can be faced in further curative therapy.
For example, people dying of cancer usually receive very aggressive treatment such as radiation or chemotherapy, these ways of treatment have side-effects which are very difficult to endure. Therefore, it is rational to want to quit the therapy if it cannot have positive results, and try to improve the quality of life. However, it happens very rarely that patients retain their rationality at such a difficult point in their life.
They tend to think that it is better to continue with the curative treatment despite its unpleasant side-effects because it implies even a small chance of recovery than to give up. However, the physicians can weigh out the negative consequences of continuing treatment and the chance of recovery it implies and determine whether it is rational to pursue further therapy. Once they do this, it is their obligation to present their judgment to the patient, and give advice on the right choice of further action.
An extensive line of research has to be conducted in this domain to equip the doctors with reliable information about the two variables so that they could give as accurate pieces of advice as possible. On the other hand, it is absolutely crucial for the patients to be realistic in their demands because only in that way can they get the best out of that most difficult situation without overburdening the doctors who already face a demanding task.
Finally, this type of care places special professional and moral obligation on the caregivers. First off, unlike the ordinary medical treatments, hospice demands that the caregivers be familiar with the patients life story.
The team has to find out about the most important things in the persons life, their goals, plans, etc. This is important because that way they can help the patient to bring their life to a close as a complete whole. Secondly, the team has to be informed about the nature of the persons disease in great detail in order to be ready for all possible issues that can come along the way.
Also, this is important because they have to know the limits of the persons abilities so as not to get them involved in activities which are physically too demanding and potentially harmful. Thirdly, caregivers have to keep in touch with current literature on bioethics and law. This is because in case of any kind of dilemma, it is best to know other peoples opinions, and learn from their mistakes and successes.
Furthermore, being informed about recent legislative changes in the domain, gives the caregivers an awareness of all legal options that are on their disposal in different situations. Fourthly, doctors and other caregivers have to know the limits of their abilities as well, because they are undoubtedly trained and able to help, but over or underestimating oneself can lead to serious consequences (Black, 1998).
In conclusion, hospice is a new interdisciplinary approach to medicine. As every other incipient discipline it faces challenges and problems. It demands a thorough cultural change in the relationship towards death and serious illness to occur first if we are to utilize the full potential of this discipline. Furthermore, the perception of hospice as a discipline has to be changed within the medical profession because many doctors tend to view it as a futile discipline because it cannot cure the patient.
Everyone has to realize that we as a society have an obligation to empathize and do whatever we can to help those who are in such a difficult situation. In that light, the government and all other institutions that fund scientific research have to consider increasing the amount of money invested in research in this domain because, as it has been stated, it is an incipient discipline which faces many problems.
At his point, doctors have to establish clear methods that can help in determining when is the right time to switch from curative to palliative treatment and educate their patients about its benefits. It is certain that the importance of this discipline will increase as the percentage of unnatural deaths is decreasing and life expectance increases. In the end, we may never be able to achieve immortality, in fact many claim that it would not be good at all, but we can certainly extend our lifespan and assure that the end of life be painless.
References
Black, T. (1998). End-of-Life Issues: Ethical Topic in Medicine. Web.
Cancer Facts & Figures 2012. (2012). Atlanta: American Cancer Society.
Gib, A. (2011). Hospice Care: Comfort and Dignity in the End. Web.
Medicare hospice benefits (2010). Baltimore, Md.: U.S. Dept. of Health and Human Services, Centers for Medicare & Medicaid Services.
Methia, R. (2010). Hospice Dying with Dignity and Treated With Very Special Care. Web.
Plocher, D. W., & Metzger, P. L. (2001). The Case Managers Training Manual. Gaithersburg, Md.: Aspen Publishers. What Is Hospice Care?. (2003). The Hastings Center Report, 33(2).
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