Regional Synod of Canada - Reformed Church in America

Pioneer Christian Monthly

Date - July/85

Contributor - Freda Witteveen

Title - Practical Aspects of Palliative Care

Topic - Dying

Immortalists are a group of people so unwilling to accept the idea of their own mortality that in their war with death they suspend bodies in a scientific form of animation until research can provide a cure for life's frailties and man can live forever.

Yet in a recent CBC series, David Suzuki spoke of the link of the cycle of life and death to the ecological balance of nature. The seasons themselves are a reminder of the transitory nature of life, and it is through these observations that many cultures believe man's immortality comes through their children.

The technological Western world too often places its faith in science where improvements in many areas of life have increased the average life expectancy from 47 to 73 years within the last century. The whole process of death and burial has also changed enormously in the last few decades. Then the individual died at home, was laid out there and services were often held in the home. Now our sophisticated society funeral parlours have substituted for the family parlour, eighty percent of deaths occur in hospitals and funeral directors look after the burial process so we needn't come into direct contact with death.

However, Dr. Suzuki points out that by turning from death we deprive ourselves of insight into our own mortality and the realities of nature, which we Christians acknowledge are under God's control.

Still finite man strives for control of his environment We do battle with all the technology available, extending life and prolonging the stage of death. We must actively refuse heroic measures designed to keep us alive, we need permission from our doctors to die and the actual moment of death is distorted.

The Bible teaches us and reminds us that the quality of life is important not the quantity, so we must consider God's will in all of these issues.

The palliative care movement in some ways reflects the religious philosophy in that the time of terminal illness should be a time of increasing maturity and a deepening spiritual experience for all concerned.

The palliative care approach involves a team of professionals in the medical field along with trained volunteers in a hospital or a home care program so that total care may be given to the patient and the family.

Pain Control

An important aspect of palliative care is pain and symptom control. Hand-holding and spiritual conversation are of little use to a person suffering from vomiting, sleeplessness and pain. Research has much to teach us about pain and pharmaceutical improvements. Pain is both acute and chronic and comprises not only the sensation of pain but the patient's emotional reaction to it. We know that pain is affected by other factors such as anxiety, fatigue and even the fear of pain and death.

Persistent pain is both debilitating and demoralizing. Medical personnel must learn how to prevent pain before it has become all-encompassing as well as dealing directly with the patient s fears. The drug is not as important as how it is used. With proper dosage and timing it is possible to erase the memory and fear of pain. A variety of measures can be used in combination, including diversional activity, such as back-rubs, access to radio and television, games, a visit from a loved one.

Staff Training

The terminally ill want their physicians to be honest and direct from the beginning. The staff must not destroy the hope that is always present in the individual until the last breath and the staff should always be accessible. All medical people involved in the care of the terminally ill should be trained with emphasis on the quality of life and a sensitization to the special needs of the dying. Volunteers who have often had personal experience with bereavement are trained in listening and communication skills and in the fundamental goals of palliative care. Staff must realize that the family needs a time of dignity and privacy for a last moment of togetherness in this life, something that often does not fit in with the busy routines of emergency rooms and wards.

The team approach must also be concerned with the emotional stress that results in the staff from balancing a caring involvement with detached objectivity. They all will need an opportunity to ventilate their feelings, sometimes of frustration and of sadness that a life has ended.

Emotional Needs

It is important in palliative care to alleviate the sense of isolation felt by the patient particularly in the hospital situation where the individual is deprived of social status, clothes and even the ability to give of him or herself.

There is a need for proper preparation of visitors, whether clergy, friends or family. The atmosphere surrounding the terminally ill now is often one of despair and helplessness, pervaded by a shadow of gloom. Visitors should be welcomed and encouraged to come regularly, even children where possible. It is also important for family to be involved where possible in the care of the patient by assisting the staff in small but useful ways. This can help to reduce the sense of loss and separation on both sides.

Dying is the loneliest experience we must undertake and out of need we turn to loved ones and others we trust for our care. If these cannot be honest the individual will retreat more and more into himself.

The terminally ill patient can have many fears: separation from family, home and job, inability to complete some task or responsibility, becoming dependent on others and of losing control of physical faculties, fear of mutilation or pain, and fear of the unknown quality of death itself, the 'how' of it.

Doctors and nurses and family must recognize these fears and be willing to discuss them in an unhurried, calm manner.

The palliative care approach counters the patient's feelings of ineffectiveness with a trend to self-help. The terminally ill person should still be able to feel they have some control, some measure of choice available to them, to be viewed and treated as a whole person. There is in most of us a desire to leave this world in a little better state than when we entered it and the staff and patient can work together to this actualization.

Conclusion

The philosophy of palliative care suggests that standards for the care of the dying be established and that sympathetic counselling should be balanced with medical expertise. Despite a variety of beliefs on the meaning of life and death, those within the situation should enable the patient to live until he dies and enable the family to go on living afterward. Our aim should be to assist the individual to attain harmony within the soul with whatever he or she perceives as truth.

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