Terminal illness

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Terminal illness is a medical term popularized in the 20th century to describe a disease that cannot be cured or adequately treated and that is reasonably expected to result in the death of the patient within a relatively short period of time. This term is more commonly used for progressive diseases such as cancer or advanced heart disease than for trauma. In popular use, it indicates a disease which will eventually end the life of the sufferer.

A patient who has such an illness may be referred to as a terminal patient, terminally ill or simply terminal. Often, a patient is considered to be terminally ill when the life expectancy is estimated to be six months or less, under the assumption that the disease will run its normal course. The six-month standard is arbitrary, and best available estimates of longevity may be incorrect. Consequently, though a given patient may properly be considered terminal, this is not a guarantee that the patient will die within six months. Similarly, a patient with a slowly progressing disease, such as AIDS, may not be considered terminally ill because the best estimates of longevity were greater than six months. However this does not guarantee that the patient will not die unexpectedly early. In general, physicians slightly overestimate survival so that, for example, a person who is expected to live for about six weeks would likely die around four weeks.

Stages

Each patient reacts differently to the news of carrying a terminal illness such as cancer. In general, almost all patients go through various stages of acceptance when a disease like cancer has been diagnosed.

The first stage is disbelief. Most people are shocked that it could happen to them, there is extreme anxiety especially about the unknown. Shock, despair and anger are common. There is also guilt that perhaps one has done something wrong to receive such a diagnosis.

Some individuals find it humorous;[citation needed] others become helpless and often start to bargain. This first stage is usually short lived and usually lasts from a few days to a few weeks.

The second stage is depression which is usually a reaction to the diagnosis. The depression is mild to moderate in intensity and needs family support. Only in rare cases is any type of medical therapy required. It is understandable to be depressed when the diagnosis of a terminal illness is made.

Duration of depression often can last several weeks but soon it fades and one goes into the final stage of acceptance.

Management

Main article: End-of-life care

By definition, there is no cure or adequate treatment for terminal illnesses. However, some kinds of medical treatments may be appropriate anyway, such as treatment to reduce pain or ease breathing.

Some terminally ill patients stop all debilitating treatments to reduce unwanted side effects. Others continue aggressive treatment in the hope of an unexpected success. Still others reject conventional medical treatment and pursue unproven treatments such as radical dietary modifications. Patients' choices about different treatments may change over time.

Palliative care is normally offered to terminally ill patients, regardless of their overall disease management style, if it seems likely to help manage symptoms such as pain and improve quality of life. Hospice care, which can be provided at home or in a long-term care facility, additionally provides emotional and spiritual support for the patient and loved ones. Some complementary medicine approaches, such as relaxation therapy, massage, and acupuncture may relieve some symptoms and other causes of suffering.

Caregiving

For the person with a terminal illness, life does not abruptly stop and a caregiver is often needed. The caregiver may be a nurse, licensed practical nurse or a family member. The individual may require assistance from a caregiver to receive medications for pain and to control symptoms of nausea or vomiting. Moreover, the caregiver can assist the individual with daily living activities and assist with ambulation. Caregivers also provide assistance with food and psychological support and ensure that the individual is comfortable at all times.

All terminal patients have different needs and have unique support needs. The patient's family may also have questions and most caregivers can provide decent information to help ease the mind. Doctors generally do not provide with estimates for fear of instilling false hopes or obliterate an individual's hope. In most cases, the caregiver works along with physicians and follows professional instructions. Caregivers usually call the physician or a nurse if:

• The individual experiences excessive pain
• The individual is in distress or having difficulty breathing
• The individual has difficulty passing urine or is constipated
• The individual has fallen and appears hurt
• The individual is depressed and wants to harm him- or herself
• The individual refuses to take his or her prescribed medications, raising ethical concerns best addressed by a person with more extensive formal training
• The caregiver does not know how to handle the situation

Most caregivers become the patient's listeners and will allow the individual to express their fears and concerns without being judgmental. Caregivers reassure the patient and honor all advanced directives. Finally, caregivers also respect the individual's need for privacy and usually hold all information confidential.

Refusal of nutrition and hydration

People who feel they are near the end of their life often intentionally refuse food and/or water. Published studies indicate that "within the context of adequate palliative care, the refusal of food and fluids does not contribute to suffering among the terminally ill", and might actually contribute to a comfortable passage from life: "At least for some persons, starvation does correlate with reported euphoria."

Dying

Patients, healthcare workers, and recently bereaved family members often describe a good death in terms of effective choices made in a few areas:

• Assurance of effective pain and symptom management
• Education about death and its aftermath, especially as it relates to decision-making
• Completion of any significant goals, such as resolving past conflicts

People who are terminally ill may or may not follow recognizable stages of grief. For example, a person who finds strength in denial may never reach a point of acceptance or accommodation and may react negatively to any statement that threatens this defense mechanism. Other people find comfort in meticulously arranging their financial and legal affairs or planning their funerals.

See also

• Anticipatory grief
• Do not resuscitate
• End of life care
• Euthanasia
• Interventionism (medicine)
• Liverpool Care Pathway for the dying patient
• Advance health care directive

References

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