A topic that is actively discussed in the Western world but still considered taboo in the Asian society. It refers to medical care of patients who have terminal illness that has become advanced, progressive and incurable as well as care during the last few hours of their life.
It is a crucial aspect of medical care. One appreciates this after having seen elderly patients with multiple co morbidities having to receive CPR (cardiopulmonary resuscitation); Or watching the pain that terminal cancer patients endure; Or watching a loved one with massive stroke being on cardiorespiratory support for a long period of time.
UK and US are proactive in advocating end of life care. Asia is following up on this aspect of medical care. However, there is active resistance, largely due to the misconception of end of life care.
Despite our advancement in medicine, only few diseases remain fully treatable. Most are just kept under control. In the cases of advance cancer or elderly patients with multiple end organ failure, efforts to make them better may be futile. In the process of trying, pain and distress is inflicted upon the patients as well as the family. (eg: during intubation or placing a central line). There is no quality or dignity in their last few days of life.
End of life care does not deny patients of their rightful treatment. But in the event where a disease is incurable and at an advanced stage, it takes over and places the patient's comfort and psychological well being as their first priority.
The 6 steps of end of life care followed by the UK
1) Discussions (as end of life approaches)
2) Assessment and planning
3) Co ordinating the care
4) Delivering the service
5) Last days of life
6) Care after Death
'If one cannot add more days to one's lives how can one add more life to the days?'
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