Helping patients face a 'good death'

By 
  • December 11, 2009
{mosimage}TORONTO - A 13-year-old girl is battling cancer, but after nine years of treatment, her doctor has run out of medication options to beat the illness and help her stay alive.

An 85-year old woman suffers internal bleeding after taking medication for a long-term skin condition and asks her doctor to stop treatment and “let her die.”

These are just two of the real-life dilemmas that health care professionals face in trying to help their patients have a “good death.”

People often think about and plan for “a good life,” but they seldom think about having a good death, according to speakers at the annual Canadian Catholic Bioethics Institute Dec. 3 lecture.

Three health care professionals spoke about what it means to have good palliative care and shared some of the dilemmas they have encountered to an audience of more than 80 people at Toronto’s University of St. Michael’s College.

Sick Kids Hospital palliative care doctor Christine Newman presented different scenarios of children near death, like a 16-year-old girl living with cystic fibrosis who was told that although she needed a lung transplant to survive, the doctor was unable to put her on the transplant list.

Newman said there is a “big societal barrier to children dying” because of general beliefs about youth.

“We live in a society where we think children aren’t supposed to die,” she said.

But kids who have a terminal illness do worry about how their death is going to happen, Newman said. The best way to try to help them is to open that dialogue and answer their questions, like what will happen to them (and their belongings) after they die, she said.

A way to help children is to “help them find what their legacy is,” such as the way the family will remember them and commemorate their lives, Newman added.

For Dr. Marisa Zorzitto, chief of geriatric medicine at Toronto’s St. Michael’s Hospital , good palliative care is about trying to “put all the elements together to facilitate a good death.”

“In general, doctors don’t give up on their patients,” she said.

On what is a good death, Zorzitto said some patients have said this means receiving comfort care and having their loved ones around them

She presented the audience with several scenarios, including the case of an 89-year-old Second World War veteran who hadn’t accepted that he was near death and wasn’t interested in reconciling with his estranged family.

“He is my dilemma. I didn’t know how to help him,” she said, adding that her patient’s denial meant he didn’t meet the criteria of entering the hospital’s palliative care unit.

Another scenario was of an 85-year-old Holocaust survivor who had developed dementia and Parkinson’s disease. He was in the hospital and developed pneumonia, then needed a feeding tube. His family made every effort to ensure he received the maximum amount of care.

“The value the family placed on life was extraordinary,” she said. 

Meanwhile, palliative care nurse Rowena Thirlwall spoke of helping homeless individuals at Perram House Hospice.

Most people who come to the hospice have similar fears about death like the fear of dying alone, Thirlwall said.

Caring for them with respect and compassion and providing comfort and medication are some of the ways to help individuals in their final days, she said.

Having a good death can also mean helping to facilitate a family reconciliation. One such opportunity came when a man reconnected with his two sons, saying to them: “I’m your father. I was a drunk. I was never there. I’m sorry,” Thirlwall recalled.

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