Monday, October 22, 2012

End-of-life care, dying with dignity

I've been reading about end of life care. A fabulous book that cites all of the issues I wrote about in my book.
Currently, with most of my clients, I do a life review with them. These are questions that get to the heart of their lives, in order to focus less on their last days.
It gives the clients a chance to look at the good things they have done, their life lessons and what they want to tell those who remain. It is a wonderful experience for both me and my clients. Usually, I write it out and print it for family members. Most, but not all, are appreciative.
This book recommends the same procedure, but says that it has to be done by a professional. Nonsense, I say. These questions provide a chance for me to focus on the contributions someone has made to the world. Too may, at end of life, look at their current situation as a failure. Yet, the only thing we can depend upon is death with taxes!

I have learned these lessons from my wonderful clients. We talk about their past, rather then current limitations. We look at a time when they were fully functioning, rather than facing functional dependencies with chronic illness, or life-limiting mobility issues.
It is good for the care recipient to learn that the rest of us can learn from them and that they still have something to contribute by accepting our support. For those with death anxiety, they can look back and get a perspective, perhaps allaying fears by questioning the caregivers. This is the Dignity-Conserving Repertoire.

Dignity-conserving care—a new model for palliative care

HM Chochinov - JAMA: the journal of the American Medical …, 2002 - Am Med Assoc
... Harvey Max Chochinov, MD, PhD, FRCPC.

Further to this, we give the client the following, by working with them to examine lives lived:
  • Continuity of Self, Role Preservation, Generativity, Legacy, Maintenance of Pride, Hopefulness, Autonomy, Control, Acceptance, Resilience and Fighting Spirit.
Dignity Therapy; Final words for final days
How do you want to be remembered?’
‘What are you most proud of in your life?’

‘What have you accomplished in your life?’
‘When did you feel the most alive?’

Dignity Therapy:  Final Words for Final Days by Harvey Max Chochinov
Oxford University PressDecember 2011, $49.95
Hardcover, 224 pages
ISBN13: 9780195176216
ISBN10: 0195176219

I often listen to a show on CBC called C'est La Vie. Usually, they speak about nuances of the French language, but this day they featured a story on Quebec's euthanasia debate.

A special commission of Quebec's National Assembly spent two years looking into issues around end of life care, assisted suicide and euthanasia. The two women who chaired those hearings say that what they heard, changed their lives. Liberal MNA Maryse Gaudreault and Parti Québécois MNA Véronique Hivon talk about that experience on C'est la vie. This is an excellent segment, worth listening to!

Dying with Dignity C'est La Vie
C'est la vie gives listeners a window into the life of French speaking Canadians through interviews with people in the news and documentaries from across the country. One of the program's most popular features is Word of the Week, a little lesson in learning the French language.

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