A century ago, most people who suffered traumatic injuries or contracted serious infections, died soon afterward. Even those who developed heart disease or cancer, had little expectation of a long life after the disease was diagnosed. Death was a familiar experience, and most people expected little more than comfort care from their doctors.
In Nigeria, according to research and statistics, about 1.5 million people die each year. Caring for patients at the end of life is an important responsibility and a rewarding opportunity to help humanity for clinicians.
Clinicians battling to prolong life must recognize when life is ending, in order to continue caring properly for thei patients. Unfortunately most clinical practice guidelines do not include significant attention to end-of-life care.
End-of-life care refers to focusing care for those approaching death on the goals of relieving distressing symptoms and promoting quality of life, rather than attempting to cure underlying disease or prolong life. From the medical perspective, the end of life may be defined as that time when death – whether due to terminal illness, acute or chronic illness, or age itself – is expected within weeks or months and can no longer be reasonably forestalled by medical intervention.
Yes, I have had a lot of people who wish, and ask, for a faster end of life for their parents or siblings, especially when they are in a vegetative state. Medically we call that “euthanasia”, and I have discussed this several times.
Clinicians must help patients understand when they are approaching the end of life. This information influences patient’s treatment decision and may change how they spend their remaining time. While certain diseases such as cancer are more amenable to prognostic estimates regarding the time course to death, the other common causes of mortality in Nigeria include – heart disease, stroke, dementia, chronic lung disease, hypertensive heart disease – remember my close family friend who suddenly collapsed last week and died of hypertensive heart disease, whom I discussed last week.
Even for patients with cancer, clinician estimates of prognosis are often inaccurate and generally overly optimistic. Clinicians can also ask themselves “Would I be surprised, if this patient died in the next year”. In the final analysis – patients at the end of life and their families identify a number of elements as important as quality end-of-life care – managing pain and other symptoms adequately, avoiding inappropriate prolongation of dying, preserving dignity, preparing for death, achieving a sense of control, relieving the burden on others, and strengthening relationships with loved ones. Always be medically guided.
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