Social work and end-of-life care

Social work is important in end-of-life care

People don’t want impersonal care and extended sickness leading to death: policy debate

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An interesting American article on how end-of-life care has developed in response to our experiences of death. Here are some aspects of that experience that the article talks about.

[In the 1960s,]…[c]omplaints arose about a lack of choice on the part of patients, doctors indifferent to the pain and suffering of those in their care, and cold, impersonal deaths lacking all dignity in a cocoon of tubes and wires.

[But still]…doctors, patients, and families drag their feet in acknowledging that death is on the way, and that is an important reason why so many of us personally know of, or have heard about, some miserable deaths where the dying went needlessly on.

[A] better coordination of care is needed: the elimination of fee-for-service medicine, which rewards physicians for their use of medical technologies but not for talking with patients; efforts to help patients die at home rather than in hospitals (and the development of more low-cost technologies to make that possible)…

The idea of unlimited medical progress that admits of no upper boundaries is not turning out as hoped. We have not found, nor are we anywhere near finding, cures for the major killer diseases. What “progress” has given us is an enhanced ability to keep sick people alive at a high cost financially and a no less high cost in terms of pain and suffering at the end of life.

And the conclusion:

We have traded off earlier, quicker deaths for later, drawn-out deaths. That bargain needs to be reconsidered.

This is an interesting critique of the impersonality of some heroic medicine, and the need for low-tech, human caring. It comes round again to some of the concerns that have led to campaigns for assisted dying. The main point is that people do not want extended sickness leading up to their death. It is not that they want help to commit suicide: it is more that people want thoughtful healthcare decisions that recognise when death is approaching and allows it to happen naturally.

Link to the article: Ethics and Healthcare

Citation: Callahan, D. and Lawler, PO. A. (2012) Ethics and Health Care: Rethinking End-of-Life Care. Discussion Paper 4, Center for Policy Innovation. Washington DC: Heritage Foundation of America.

(This is an American conservative think tank).

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Written by Malcolm Payne

31 July 2012 at 3:43 pm

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