While the end of life is inevitable for all living beings, that does not make accepting it easy or simple. For family and friends, it is the loss of someone who is loved. For the patient, it is a matter of accepting the inevitable and being at peace when the end comes. Caring for the well-being of those whose remaining life can be measured in months instead of years is a specialized medical discipline. It is known as hospice or end-of-life care and the objective is to help the patient prepare physically, mentally and emotionally for the end of life. Providing this kind of support enables people to prepare for the end in the way that suits them best and to face death with dignity.
What Is End-of-Life Care?
There are no specific parameters that define the nature of end-of-life care. The nature of that care depends on the patient’s medical condition, factors that contribute to the progression of the condition and the psychological needs of the patient. That said, end-of-life care is normally divided into 4 levels:
- Routine Home Care: The patient remains at home and is cared for by loved ones and also by regular visits from health care providers.
- Inpatient Care: The patient is suffering from severe pain, discomfort or other symptoms that cannot be managed at home. The patient is moved to a hospital, nursing home or specialized hospice facility.
- Continuous Home Care: This is for patients who would benefit from inpatient care but who do not want to go to a hospital and prefer to end their time at home. Patients receive intensive care for short periods to give them the maximum possible comfort in their home environment.
- Respite Care: This is a short-term hospital/nursing home/hospice stay after which the patient returns home. This is done when the patient is suffering from short-term pain or discomfort that can be alleviated by inpatient care for a specific time, after which the patient returns home. It may also be done to give caregivers some rest from their responsibilities and pressures of providing end-of-life care.
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The Aim of End-of-Life Care
The objectives of end-of-life care are:
- To provide physical and medical support to alleviate pain and discomfort and give patients the best quality of life prior to their passing.
- To provide patients with the knowledge that they will end their days with the best possible care and support as this will reassure them as they prepare for the end.
- An end-of-life situation can lead to deep psychological stress and trauma in both patients and loved ones. The knowledge that all steps are being taken to care for the patient will provide comfort to both the patient and his/her loved ones that there is nothing more that can be done.
- Patients at the end-of-life stage often need emotional and psychological support as they prepare for the end. The specialized care they receive will relieve much of their stress and fear.
- As people face the end of their lives, the way they interact with others may change. Dealing with these personality changes is never easy and professional end-of-life care will help both patients and their loved ones deal with these changes and will mitigate any stress they may cause.
- People with terminal medical conditions need to make many decisions about the kind of medical support they want, financial matters and what their families should do after they are gone, etc. Professional medical care will ensure that patients are competent to make such decisions and will help them clearly communicate their wishes to those they leave behind.
- Terminal medical conditions may result from more than one cause. End-of-life care will involve medical professionals from all relevant specializations to ensure that holistic care is given.
- End-of-life involves many ethical matters such as the continuation of artificial life support, organ donation and so on. Helping patients and families understand and deal with these matters is a part of end-of-life care.
- When patients pass away, families often feel guilty and wonder what more could have been done. End-of-life care means that such doubts do not arise and that loved ones may grieve without the added burden of guilt.
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The Stages of End-of-Life Care
End-of-life care is a process, not an end in itself. It involves several stages:
- Diagnosis: A medical condition is diagnosed as being untreatable and terminal.
- The patient and family are informed of the situation.
- The patient and family are given some time and the support required to come to terms with the inevitability of passing.
- A care plan is devised that considers the nature of the condition, the wishes of the patient and family, and the ethical issue involved with life ending.
- The plan is put into effect and is periodically reviewed and modified, as the condition of the patient demands.
- The care and support continue till the patient passes away and the doctors can do no more.
No two people are the same and no two end-of-life situations are identical. The support that a person is given to face the end with dignity and the maximum comfort and consideration does impact the final days of life. It gives patients the support they need to face the end in peace and provides those left behind with the comfort of knowing that all that was possible was done for their loved one who is no longer with them.
A diagnosis of a fatal medical condition is never easy for any of those involved. Being diagnosed and being given medical care at a top-level multispecialty hospital will ensure that all possible steps are taken to treat the patient and when the condition reaches the terminal stage, the best possible end-of-life care will be provided allowing the patient to pass on with dignity and in comfort and peace. Knowing this is the best comfort for those left behind.