End Of Life Care

We have to ask ourselves whether medicine is to remain a humanitarian and respected profession or a new but depersonalised science in the service of prolonging life rather than diminishing human suffering.
-- Elisabeth Kubler-Ross

Stanford End Of Life Care Course is a good starting point, you can download the PowerPoint slides from this website.

AFP discussed Making Decisions with Families at the End of Life in the August 2004 issue. There is a patient information handout that you can you give to your patient or relatives to help them make an informed decision.

The Nortwestern University palliative care website as a good starting point when managing common symptoms like pain, nausea, vomiting, constipation, etc.

AMA's EPEC Project (Education for Physicians on End-of-life Care) has donwloadable modules with case descriptions and management.

Hospice is specialized care for terminally ill patients who have less than six months to live. As the hospice movement in America observes its 30th anniversary, NPR offers an audio portrait of Kitty Shenay, one of more than 900,000 Americans expected to benefit from hospice care this year. National Public Radio (NRP) has a special section dedicated to the end of life care.

Psychiatrist Elisabeth Kubler-Ross, who revolutionized the way the world looks at terminally ill patients died at age 78 in August 2004. She described the 5 stages that patients and their relative often go through before death: Denial, Anger, Bargaining, Grief, and Acceptance. (A useful mnemonic is: Death Arrives Bringing Grave Adjustments). NPR remembers Ms.Kubler-Ross in 2 programs which you can hear on their website.

PBS journalist Bill Moyers did a landmark TV documentary on end of life care in 2001. Click here to go to the "On our own terms - Moyers on dying" website.

Related Video


Do Not Resuscitate (DNR) Sung to Rockstar by Nickelback

References:
Cicely Saunders Dies at 87; Reshaped End-of-Life Care - NYTimes 7/05
A memorable patient - The unwanted diagnosis - BMJ 8/05
Will We Ever Arrive at the Good Death? - NYTimes 8/05
Listen to an interview with Dr. Susan Block and medical student Christie Sullivan on Sullivan's first experience with a terminally ill patient - NEJM 9/05
Listen to SCCM PodCast - Getting Our ICU Language Straight 12/05
On Our Own Terms: Moyers on Dying. The Mount Sinai Medical Center, 45 min, $ 5

Related:
The Guardian: A sombre series of portraits taken of people before and after they had died is a challenging and poignant study, 03/2008.

"Life has a 0% survival rate" http://goo.gl/dWmq - Another post by Dr. Rob that should be required reading whether you agree with it or not
WJM, Volume 163(3); September 1995. http://www.ncbi.nlm.nih.gov/pmc/issues/124736
A Son's Photo Journal of His Aging Father's Decline - Photo Essays - TIME http://goo.gl/RVCt

Updated: 04/26/2010