1 Too much technology Too little care Dr Anna Holmes Department of General Practice University of Otago.

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Too much technology

Too little care

Dr Anna HolmesDepartment of General Practice

University of Otago

Too much technology : Too little care

Talk in threes about why you have come and what you want to explore in this session?

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Too much technology : Too little care

Outline

Why have you come here?

Where would you like to die?

From care to clinical detachment and cure

What makes a good or bad death?

The pressure for euthanasia

Advance care planning

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Too much technology : Too little care

Where would you like to die?

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Too much technology : Too little care

Healing means to make whole. It is the alleviation of suffering in illness by finding new meaning, reconnection and reintegration of self with the family and community. It deals with physical, mental, spiritual and social aspects of the patient. Cure of disease may or may not happen.

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Too much technology : Too little care

Cure is the removal of disease by medical or surgical means. It focuses on the pathology of individual organs, systems and people.

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Too much technology : Too little care

“He told me there was nothing else he could do and sent me to the hospice. He shouldn’t have taken away my hope”

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Curing is not enoughShe had been referred for different physical symptoms, bytwo GPs, to four specialists in a year. All investigations had been negative. She finally came to see the last doctor in the practice with a new complaint. This doctor commented on the referrals and asked

‘When did this all begin?’

The patient burst into tears and replied ’When my father died.’ After a period of silence she said ‘Perhaps I need to do some more work on grief.’

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Too much technology : Too little care

What makes a good or bad death?

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Too much technology : Too little careTen key elements of care for the dying patient1 Recognition that the patient is dying2 If possible communicate with patient ,family and loved ones3 Spiritual care4 Anticipatory prescribing for symptoms - pain, mucus secretions, agitation, nausea,vomiting, brathlessness5 Review of clinical interventions should be in the patient’s best interests. 6 Hydration review, including the need for commencement or cessation.7 Nutritional review, including commencement or cessation.8 Full discussion of the care plan with the patient and relative or carer9 Regular reassessment of the patient10 Dignified and respectful care after death for family and patient 10

Too much technology : Too little care

Why do people seek euthanasia?

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Too much technology : Too little care

Advanced Care Planning (ACP)

Advance care planning is a process of discussion and shared planning for future health care.

It is focused on the individual and involves both the person and the health care professionalsresponsible for their care.

It may also involve the person’s family/whanau and/or carers if that is the person’s wish.

Too much technology : Too little care

To make a valid Advance Directive

Person must be mentally competent

Choice made freely

Must be informed of options

Directive must be written in notes

Signed by patient and health professional

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Too much technology : Too little care

Advace care planning may include :

Advance directives

Not for cardiopulmonary resuscitation

Living wills

Enduring power of attorney

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Symbols of hope

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