Lately, there has been a great deal of discussion in the news, in the courts and more recently in parliament, regarding “end-of-life”. Just last week, Manitoba Conservative MP Steven Fletcher tabled a private member’s bill that proposes the enabling of “assisted dying”. Mr. Fletcher, who was left a quadriplegic after a car accident, was interviewed on the radio which I had the opportunity to listen to. It was intriguing to hear about the topic of “assisted dying” from the perspective of someone who at one time found himself caught between death, and a life that was not of his choosing.

You may also recall the Rasouli vs. Sunnybrook case that sparked a national debate about healthcare professionals providing what they deem to be “futile” care. The Supreme Court ruled that doctors could not withdraw life support with without consent from the patient’s family (substitute decision maker).

My intent in raising this issue is not to discuss the relative merits or pitfalls of assisted death, but rather to highlight the essential role that RTs play to ensure that the end of their patient’s life is as dignified as possible. We may or may not have been part of the conversation with the patient and their family about the decision to stop treatment; however, we are often the healthcare professional standing at the bedside withdrawing the life support. There was a commentary in The Globe and Mail last week stating that “often, the dying aren’t afraid of death – but of dying badly”.i  Therefore, how an RT interacts with the patient and supports the family at this very difficult time is immensely important.

If we consider the process of dying from the perspective of the patient and their family (many of whom likely have little experience with hospitals or the dying process), it’s easy to understand that what we say is just as important as what we do. Carefully explaining to the patient (regardless of whether we think they can hear us or not) and their family about what is going to happen and what to expect seems like such a little thing. But simple explanations and clear communication go a long way towards easing the anxiety and uncertainty surrounding death – and can make a very big difference.

 


i Renzetti, E. (2014, March 31). While we hesitate, the terminally ill are denied a peaceful end. The Globe and Mail.

COMMENTS | The RT Difference in End-of-Life Care

  1. This is an interesting topic. As an RT working in critical care I deal with death all the time. It is something that I feel RT school did not prepare me for. It’s been over 10 years since I graduated and started working, and in that time I’ve gotten used to withdrawing care and what it’s like when a patient dies, but I don’t think I realized in the beginning that death would be such a big part of what I do. RT school taught me to figure out what was wrong and how to fix it, not what to do when things can’t be fixed anymore.

    I’ve had this discussion with coworkers on a few different occasions and they say the same thing. School didn’t really prepare them for this part of the job.

    I’d be curious to know if there is something in the curriculum now that covers death and dying..not just the biology of it but the interpersonal side of it as well.

    • Daphne makes a very valid point, about our role in end of life care and the current curriculum. An introduction to our role as family and patient advocates and the “ethical” dimension of Respiratory Therapy would be extremely beneficial to new graduates entering the field. As medical technology continues to advance we will encounter more situations that make us wonder what action is in the best interest of the patient respecting their values and wishes.

      Withdrawal of life support is usually a very emotionally charged event for the family. This can be an extremely difficult decision for a family to reach, and there is often a great deal of fear of the unknown. Will my loved one suffer? How long will it take? At this juncture of care, all the family and healthcare team can hope for is a “good death”. This will be the last memory for family members present, so it is important for us as healthcare professionals to make the patient as comfortable as possible. This can usually be achieved with effective coordination and communication with other staff involved. Carefully communicating to the family members what steps will be taken, may alleviate their fears. Empathy with their situation is paramount. They will likely remember the events of this day for the rest of their lives and your role as the RRT is pivotal in their experience of a difficult situation.

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