Lecture 11 - Navigating Death, Dying, and Palliative Care with Families

What does a 'good death' entail?

- Free from avoidable distress and suffering

- Respects patients' and families' wishes

- Consistent with standards

- No blueprint

- Based on preference

- Considers various needs

What does palliative care seek to do?

To improve a person's quality of life once a chronic, life-limiting condition is diagnosed.

Palliative care ends at death (True/False).

False

The purpose of palliative care is to hasten or postpone death (True/False).

False

What is end-of-life care?

Care that starts in the final stage of dying to relieve suffering and improve quality of life until death.

Palliative care can be applied early in the course of illness, and it doesn't have to be near death (True/False).

True

What is the primary goal of palliative care?

To relieve pain and other distressing symptoms while affirming life and regarding dying as a normal process.

What approach does palliative care use?

Palliative care uses a team approach to address the needs of patients and their families.

What is the foundation of palliative care?

Person-centered care.

What principles are involved in palliative care?

Dignity, hope, comfort, quality of life, and relief of suffering.

The focus of palliative care is not on prognosis but on individuals' needs and wishes (True/False).

True

What do patients and families want during palliative care?

- Honest and direct information

- Compassion and empathy

- Time to process information

- Supporting hope for a cure

What are 3 questions you can ask yourself to make difficult conversations about serious illness easier?

- Is a treatment of care decision needed?

- What do they know?

- What matters most?

What are the 3 components of family meetings?

- Prepare for the meeting

- Conduct the meeting

- Document and follow-up

What is a Substitute Decision Maker (SDM)?

A person appointed to make decisions on an individual's behalf if they become incapable.

What did the Supreme Court of Canada rule in the case of Cuthbertson vs. Rasouli (2013)?

The SDM must have a say in decisions regarding life support measures.

What are the ethical considerations regarding life-prolonging treatment?

They must not be based on fear, prejudice, or convenience.

What do dying people want?

Truth, reassurance, hope, closeness, and time.

Hope is not limited to escaping death, and it could also refer to hope for something after death (True/False).

True

What does the term 'living parallel realities' refer to in palliative care?

It refers to acknowledging the terminal nature of the disease while maintaining hope for a cure.

What does MAID stand for?

Medical Assistance in Dying.

What are the current eligibility criteria for MAID in Canada?

- Eligible for health services funded by Canada

- Must be at least 18 years old

- Capable of making health decisions

- Provided informed consent

- Have a grievous and irremediable medical condition

What defines a grievous and irremediable condition for MAID eligibility?

- Has a serious and incurable illness, disease, or disability

- Is in an advanced state of irreversible decline

- Suffering cannot be relieved under the conditions that the person deems acceptable

What is informed consent in the context of MAID?

Discussing all reasonable treatment options and ensuring the person understands the implications of their choice.

What should healthcare providers inform patients about regarding MAID?

Possible complications, the ability to withdraw their request, and the means available to relieve suffering.

Once a person consents to MAID, they cannot withdraw their consent (True/False).

False

What is capacity?

The ability to perceive and remember information and communicate a choice.

What are the 3 parts of capacity with regard to MAID?

Understanding, appreciation, and processing.

What does understanding mean in relation to capacity?

Having a clear perception of the meaning of the choice to be made.

What does appreciation mean in relation to appreciation?

Having appropriate critical judgment to see the value of what is understood.

What does processing mean in relation to appreciation?

The ability to plan and execute actions rationally and consistently in response to a decision.

What is the nursing responsibility regarding MAID?

Acquire knowledge and skills for end-of-life care, understand the legal framework, and inform employers of conscientious objections.

What should nurses do if they have a conscientious objection to MAID?

Connect the person asking for MAID to someone who does not have an objection.

MAID is considered as the most severe form of palliative care (True/False).

False

End-of-life care should be explored first before resorting to MAID (True/False).

True

What are the components of quality end-of-life care?

Symptom management, necessary medical services, social services, and psychological support.

What is a death doula?

Someone who helps people have a good death.

Who is Stephen Jenkinson?

A former leader of a palliative care counseling team known for advocating changes in the dying process.

What does Stephen Jenkinson want to do?

Turn the act of dying from denial and resistance into an essential part of life.

What is the process of grief and loss?

It is an adjustment and healing process, viewing loss as a wound and grief as the healing.

Grief is not an illness (True/False).

True

What are the 4 different types of grief?

1. Anticipatory

2. Disenfranchised

3. Ambiguous

4. Prolonged/complicated

What are the stages of grief according to the common model?

- Denial

- Anger

- Bargaining

- Depression

- Acceptance.

The stages of grief is a linear process that starts with denial and ends with acceptance (True/False).

False

How can grief manifest?

- Cognitively

- Affectively

- Somatically

- Socially

- Spiritually

What is the nurse's role in the grieving process?

- Companioning

- Active listening

- Encouraging reminiscing

- Normalizing responses

- Assisting in meaning-making

What is compassion fatigue?

The emotional strain experienced by healthcare providers due to repeated exposure to suffering.