Caring and curing

May 08, 2018

This blog was written by Min-Jee Kim as part of her internship placement with Maxim Institute’s research team. 

“It has become taboo to mention dying,” says Kathryn Mannix, a leading palliative care specialist from the UK. I know what she’s talking about. In my time as a junior doctor in New Zealand, I learnt to use euphemisms when certifying many deaths, saying, “I am sorry, she has passed away.” I would give a moment of silence, walk out to fill out the paperwork, and say to myself: “okay, no time to waste, sick and alive patients are waiting.”

What I didn’t understand at the time was that I associated death with defeat. As doctors trained primarily to cure patients, we think we have failed. With the advancement of medicine, many previously fatal diseases are now treatable and society is no longer as threatened by death. We have developed an ideology that “death can be defied” and denied, argues nurse ethicist Helen Stanton Chapple. Yet the undeniable truth is that eventually, we all die. But we face a health system that is not geared to provide care for the dying, and our people fear the prospect of death.

What I didn’t understand at the time was that I associated death with defeat

Fortunately, we do have excellent hospice services, where specialist nurses and doctors provide symptom relief in the community and inpatient units. New Zealand was even ranked as the third best in the world for palliative care by the Economist Intelligence Unit in 2015. Their approach is to affirm life and regard dying as a normal process, intending neither to hasten nor postpone death, giving patients and whānau the opportunity to explore their values and concerns, and importantly, ways to improve their quality of life. We need to extend and celebrate palliative care, and perhaps, this may even break the taboo and ease fear around death.

A good first step is to increase the weight palliative care training is given in undergraduate medical, nursing and allied health degrees. In my six-year degree, I only spent a few days dedicated to palliative care, nowhere near enough to prepare me with the medical and interpersonal skills needed. Nor was much time devoted to discussing moral and ethical questions that underpin medicine.

In my six-year degree, I only spent a few days dedicated to palliative care

With more focus on palliative care during education, all future health care professionals could learn the nuances of how prevention, cure, and care overlap yet differ in health—exploring questions like when it’s appropriate to stop life-sustaining treatments while care continues, and how to lead conversations in ways that uphold and affirm the dignity of the patient. Increasing the number of medical professionals who are trained in primary palliative care provision would do wonders. Promisingly, the Ministry of Health has increased the emphasis on primary palliative care as one of the five priorities in the recent Palliative Care Action Plan.

When the health care system and society start to accept death as a natural part of life, we will give more dignity to the dying. We will learn to celebrate a life despite the death at the end. It is time for medicine to be a profession that takes seriously the responsibility to care as well as cure.

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