From: "Dr. D. Kossove" <doctordee@telkomsa.net>
Subject: End of Life Issues   Marcia Koch
Date: Wednesday, December 03, 2003 4:25 PM

End of Life Issues

When a patient's doctor(s) decide that their cancer can no longer be controlled then it is time to address End of Life Issues.  Scans and aggressive treatments can be stopped, but they do not need to. One can pursue aggressive treatment for as long as they wish. In the event a patient chooses to concentrate their treatment on simply being comfortable the general care continues just in a different manner. The patient receives medications and treatments to control pain, regular medicines the patient is currently taking (e.g. heart medications), oxygen when prescribed and virtually any other medicines or equipment needed to keep the patient at ease and follow their wishes.

Hospice Care is widely recognized and accepted at this point. A patient can remain at home, go into a hospital or care center and choose to receive Hospice Care. Under Hospice Care the patient will be assigned a nurse, doctor, medical and social workers, sitters and shoppers when needed and many aspects of mental/spiritual help as needed and desired. This help can include the patients family and/or caregiver also as needed, there are Hospice Volunteers who are trained to give the caregivers specific help or simply a much needed break. The patient can get help with legal issues such as Living Will, Medical Power of Attorney, all sorts of Advance Directive needs.

All peoples End of Life needs will be as unique as the individuals involved. Cultures, religion and personal belief systems are very important to the patient at this time. These beliefs should be explored, expanded and respected by loved ones to ease the progression. Two examples of individuality: A woman made the decision to remain at home and to be surrounded by her loved ones as her time to pass-on approached. She preplanned her funeral and assigned decision makers based on specific scenarios. A gentleman instrumental in building a church (therefore surrounded by many who would have been compelled to be of assistance however estranged from his family) decided to be alone as his time came in the care of a Hospice Home Center.

Even though death and dying are taboo subjects in our society, communication is the key for all involved to facilitate the entire process. Counseling helps! If you have not seen a counselor during the cancer process then a Hospice can help with this as well. Dealing with End of Life issues is not a death wish or death sentence. In mainstream societies today there are many legal issues as well as comfort issues to be considered. The patient and loved ones need not be burdened with these issues when they can be taken care of ahead of time and with the help of experts. The end times of the patient should be spent the way they desire not entwined with complicated decisions.

Hospice Sites on the internet contain most of the same information. Below is a collection of URLs listed below with special sections that could be especially helpful.

Hospice Net  Pain Control: Dispelling the Myths and a Childrens section that includes Teenager issues.
This site includes U.K. and International Find a Local Hospice Links.
http://www.hospicenet.org/

Hospice Foundation  Has a really good Resource Section.
http://www.hospicefoundation.org/

National Cancer Institute  Link to NCI  Advance Directives Page
Good Laypersons explanation of Advance Directives
http://cis.nci.nih.gov/fact/8_12.htm

Beliefnet offers a good cross-platform section on Mortality for those of various faiths.
http://belief.net/index/index_700.html

American Psychological Association
Good General Fact Sheet, very informative, good perspectives
http://www.apa.org/pi/eol/homepage.html


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