INTRODUCTION TO PALLIATIVE CARE

1. INTRODUCTION TOPALLIATIVE CARE Rels 300 / Nurs330 6 November 2013

2. Of Life and Death, Ch. IIIPalliative Care The task of the Senate committee was to evaluate the ethical, social, legal and medical issues related to assisted suicide and euthanasia. • What are the alternatives to assisted suicide and euthanasia? • what if the only alternatives are pain, suffering, despair, isolation, and home caregiver burnout? 300/330 - appleby

3. Dr. Neil Macdonald, Montreal “One cannot in a moral society consider terminating a fellow citizen’s life, if that citizen is suffering because of lack of access to good palliative care. Regardless of one’s views on euthanasia, one must concur that, as a first principle, impeccable care for dying citizens must be ensured.” • this Committee was convened in 1994, reporting in 1995 • the Canadian Palliative Care Association was founded in 1991 • how accessible do you think palliative care was in 1994? 300/330 - appleby

4. Reports of witnesses • the need for palliative care is great • palliative care improves the care of the dying and enhances their quality of life • palliative care is available to only a small percentage of dying people • palliative care services are very unevenly distributed across Canada 300/330 - appleby

5. Reports of witnesses • palliative care most often focuses on cancer patients to the neglect of people dying of other diseases and conditions • palliative care services are severely under-funded • some health care professionals receive little to no training in palliative care • there is very little research on pain relief and symptom management 300/330 - appleby

6. Committee Recommendationson Palliative Care • Make palliative care programs a top priority in health care system restructuring • Develop and implement national guidelines and standards. • Train health care professionals in all aspects of palliative care. • Develop an integrated approach to palliative care that coordinates institutional, hospice and home care with respite services and volunteer support. • Expand and improve palliative care research, especially in pain control and symptom relief. 300/330 - appleby

7. GOALSof palliative care Hospice palliative care aims to: • treatall active issues • preventnew issues from occurring • promoteopportunities for meaningful and valuable experiences, personal and spiritual growth, and self-actualization. Hospice palliative caremay complement and enhance disease-modifying therapy or it may become the total focus of care. → CARE DIAGRAM 300/330 - appleby

8. CARE DIAGRAM http://www.chpca.net/publications/norms/II.pdf 300/330 - appleby

9. Palliative care’s central values: • The intrinsic value of each person as an autonomous and unique individual. • The value of life, the natural process of death, and the fact that both provide opportunities for personal growth and self-actualization. • Care is guided by quality of life as defined by the individual. 300/330 - appleby

10. http://www.youtube.com/watch?v=q3jgSkxV1rw[7:14] “Eight days before he died of a brain tumour, Dr. Donald Low, the microbiologist credited with guiding Toronto through the 2003 SARS crisis, makes a final plea for Canada to change the law to allow assisted suicide.” • http://www.cbc.ca/news/canada/toronto/sars-doctor-donald-low-s-posthumous-plea-for-assisted-suicide-1.1866332 • [http://youtu.be/q3jgSkxV1rw] 300/330 - appleby

11. End-of-life Pain

12. Chapter 6: Physical Comfort http://as800.chcr.brown.edu/pcoc/resourceguide/chapter6.pdf [http://as800.chcr.brown.edu/pcoc/]

14. Assessing Pain

15. Wong-Baker FACES Pain Rating Scale

16. Of Life and Deathhttp://www.parl.gc.ca/35/1/parlbus/commbus/senate/com-e/euth-e/rep-e/lad-e.htm#iv “Many witnesses repeatedly indicated that . . . sufficient medication to control pain is not being provided. “Several witnesses suggested this is due to a lack of training and education of medical professionals in the area. Others stated that some medical professionals fear liability if the administration of drugs to control pain results in a hastening of death. “Finally, fear of addiction of patients was also offered as a further explanation for the failure to provide adequate pain control in some circumstances.”

17. Treatment Aimed at the Alleviation of Suffering that may Shorten Life “Palliative care that results in death is not considered to be criminal, so long as four conditions are satisfied: (1) the care must be intended solely to relieve suffering; (2) it must be administered in response to suffering or signs of suffering; (3) it must commensurate with that suffering; and (4) it cannot be a deliberate infliction of death. Documentation is required, and the doses must increase progressively.” (recommendation of the Can. Bar Association)

18. CNA – Position Statement Providing Nursing Care at the End of Life September 2008 Excerpt from statement: “Pain and symptom management” http://www.cna-aiic.ca/CNA/documents/pdf/publications/PS96_End_of_Life_e.pdf “Appropriate pain and symptom management is a key component of end-of-life care and addresses one of the common concerns expressed by dying individuals: a fear that they will experience pain and suffering. Although increasing doses of pain medication may, in very limited instances, have a secondary and unintended effect of hastening death, this action is ethically justifiable if the dosage of pain medication is adjusted appropriately and the primary intent is to relieve pain.”

19. http://www.pallium.ca/infoware/DFC_TranscriptELVEng_March2006.pdfhttp://www.pallium.ca/infoware/DFC_TranscriptELVEng_March2006.pdf Video clip: Dying for Care