Behind the Article: Dying with Dignity

Posted by: Bob Stott

Last week, an article of mine went live on the Therapy Times site, entitled "Dying with Dignity", focusing on palliative care professionals and respiratory therapists coming together to aid the terminal patient. While I didn't face the usual struggles I come across when writing an article – wading through PR fluff or "reliable" sources who pack up and leave for Indonesia (oh, it happens) – I still ran into a bit of a writing wall.

With a lot of articles in which I spotlight therapists combating some tragic or debilitating trauma, I do my best to show both sides of the story: the tragedy but at the same time, the silver lining where therapists' efforts are making real differences. End-of-life therapy took me somewhere else entirely. On a topic like this, it was hard to locate that time-honored silver lining.

Also, covering a subject so intertwined with personal spiritual beliefs, I was having some minor troubles trying to walk a politically correct tight rope. Myself an agnostic and out-of-practice Catholic, I didn't want to validate or discount anyone's spiritual perspective on the proper management of end-of-life therapy. While illness and dying are a normal part of life, everyone, even therapists and palliative care workers, seem to have different ideas of where one's own spirituality fits into the process.

The Joint Commission has an accreditation standard that includes the patient's right to spiritual care and support, and although clinicians may recognize the need to provide spiritual care, many are understandably uncomfortable asking questions about spirituality or religion, for fear of superimposing their own ideas on the patient. From my research, it's clear, even today, that the relationship between spirituality and the patient's coping abilities is relatively new in the therapeutic literature. The number of studies addressing spirituality has tripled in the past five years alone.

Unwilling to make a spiritual stand myself, I decided to focus on the medicine of end-of-life field. Going into a topic like this, you have a misconception that the elephant in the room will be the removal of ventilator from the patient, the allowance of the patient to die – that very Grey's Anatomy-esque drama. But the entire road to this point can be a gauntlet, from dealing with hostile family situation to juggling demands for more aggressive preventative treatments.

Choosing to embrace palliative care over aggressive treatments is not giving up, and it's not giving in. A patient's decision to change the focus of their treatment from "cure" to "comfort" is about weighing quality of living versus quantity of life. It is about clarifying choices and the goals of the individual and family. As the patient juggles the aspects of palliative care – holistic care, pain management, home versus hospice care, spiritual issues, and familial support – experts say its crucial that healthcare professionals remain supportive of these decisions.

Its been an interesting article, seeing this hot topic from a lot of different angles, and coming to terms with my own ideas of mortality and end-of-life has been a real eye-opener. By all means, if you'd like, read my article and let me know your own unique perspective about patient management in end-of-life care.