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Monday 17 October 2011

Time has come to talk about dying – doctors

MODERN medicine has shifted its focus to prolonging life at all costs, but it’s time to put the planning of end-of-life care back on the agenda, according to an editorial in the Medical Journal of Australia.
Intensive care physician William Silvester and respiratory physician Karen Detering from the Respecting Patient Choices Program say advance care planning is beginning to be recognised as a pivotal part of end-of-life care.
“Our common law duty of care as doctors is to always act in the patient’s best interests,” they say in their editorial.
“One of the most practical ways to put this into action is to regularly ask ourselves: ‘Am I caring for this patient or family the way that I would want myself or my family to be cared for, by taking the time to identify their personal, spiritual or religious views and take these into account when I am making decisions?’”
The authors say it’s important for doctors to ensure patients’ consent to treatment is fully informed, by understanding their goals and values and by identifying their wishes regarding treatment if they become seriously ill and can no longer decide or communicate what they want.
Doctors need to talk to the family when a patient is no longer competent to make decisions and to know ahead of time what a person would want, they say.
“More than half of us are not in a position to express these preferences at the end of life,” the authors say.
In a separate MJA article, palliative care doctors Brian Le and Michael Chapman outline a case which raises the question of “whether a person has the capacity to make decisions for him- or herself” regarding end-of-life care”.
The issue is “likely to become an increasing problem, as palliative care services care for an ageing population, with a significant comorbid burden, who are more at risk of diminished capacity due to the prevalence of illnesses such as dementia”, they say.
Source:Cowra community News

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