| Abstract |
The medical achievements and the development of medical technology
are the common place of the fulfillment of expectations as far physicians,
scientists and people-patients are concerned about the prolongation of life.
However, this kind of treatment of health and life can’t be plausibly covered at the
exceeding, since the existence of incurable diseases, which consists the biggest
percentage of death causes in the contemporary world, shows that there is a
need of a more careful and significant management of those cases.
The common feature that characterizes the situations that are mentioned
above, either they lead to a gradual impoverishment of human organism (cancer,
renal failure, Alzheimer) either to sudden death (heart failure), is the fact that they
are illnesses which bring patients into an irreversible condition, accepting and
expecting the moment of their dying. In particular, “terminal patients5” are
considered those patients that are in an irreversible or non curable condition,
which might lead them to death, in a short time of period (one year) with or
without medical intervention. As for the disease itself is considered the condition
that is medically confirmed as non curable and irreversible, leading patients to
death more or less in six months. On the base of all these facts, the current,
national health systems, social and hospital policies have gradually started being
differently organized in relation to the way of treatment of illness and patients’
ethical coverage6.
In the past, as also these days of course, there was a focus on the
“aggressive” medicine or treatment till the last moments of the patient. This had
an equivalent, exhausting effect on the physical and mental state of the terminal
ill people. The more increasing interaction and familiarization of public opinion
with the medical facts and the gradual enforcement of patient’s role through
his/her participation in the way of decision making, brought in the spotlight, apart
5 Margaret A. Drickamer, MD; Melinda A. Lee, MD; and Linda Ganzini, MD, 1997, “Practical Issues
in Physician-Assisted Suicide”, Annals of Internal Medicine, 126(2), p. 148
6 Diane E. Meier, R. Sean Morrison, Christine K. Cassel, 1997, “Improving Palliative Care”, Annals of
Internal Medicine”, p. 225-230
from the duties and the power of physician (according to the medical code of
deontology), the power of the patients, too (based on safeguarded rights). In this
way, it is clear that a patient shouldn’t be treated as a reflection or an expression
of illness, but as an agent of will, desires and emotions.
For this reason, it has been started emerging different types of care within
the hospital frameworks which focus on the provision of health care to patients at
the last stage of their lives (end-of-life care, terminal care). This new perspective
is due to people’s desire, regardless of their cultural origins, having a “good”,
“dignified” death. This request or wish is differently expressed by each person
and it is always in relation to the region of the health care services provision
during the end of life, as each hospital unit or medical team follows variant
policies. For instance, in few hospitals physicians’ decisions that refer to terminal
patients are based on tactics such as: life sustaining7, withdraw and withhold
treatment8, CPRs (Cardio Pulmonary Resuscitations) or DNRs (Do Not
Resuscitate), or even euthanasia or physician assisted suicide if the
institutional and the legal system of a country permits it, e.g. Holland.
The aim of this dissertation is to set a central speculation about the special
and sensitive category of terminal patients who are traced into all the human
societies, the corresponding services and structures for this group of people
(end-of-life care, terminal care) in hospital (intensive care unit, palliative care,
DNR, euthanasia or assisted suicide) and public policy level (hospice care, home
care, supportive care) and finally, the bioethical issues that arouse in regard to
the kind of choices that are made about the health care forms. As such could be
considered the advocacy and the protection of the ethical values of patients, the
distributive justice (social, political and financial factors), as far the way of health
care provision and other social conditions are concerned, which influence the
content of physicians and patients’ decisions in the way of conducting terminal
care procedures.
7 Gerhild Becker, MD, MTh, Robert Sarhatic, Msc, Manfred Olschewski, Msc, Carola Xander, Msc,
Felix Momm, MD, and Hubert E. Blum, MD, University Hospital Freiburg, 2007, “End-of-Life Care
in Hospital: Current Practice and Potentials for Improvement”, Journal of Pain and Symptom
Management, 33(6), p. 713
8 Charles L. Sprung, MD, Simon L. Cohen, MD, Peter Sjokvist, MD, Mario Baras, PhD, Hans-Henrik
Bulow, MD, Seppo Hovilehto, MD, Didier Ledoux, MD, Anne Lippert, MD, Paulo Maia, MD, Dermot
Phelan, MD, Wolfgang Schobersberger, MD, Elisabet Wennberg, MD, PhD, Tom Woodcock, MB, BS
for the Ethicus Study Group, 2003, “End-of-Life Practices in European Intensive Care Units-The
Ethicus Study”, JAMA, 290(6), p. 791
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