Terminal illness

Terminal illness is a medical term popularized in the 20th century to describe an active and malignant disease that cannot be cured or adequately treated and that is reasonably expected to result in the death of the patient. This term is more commonly used for progressive diseases such as cancer or advanced heart disease than for trauma.

A patient who has such an illness may be referred to as a terminal patient or terminally ill. Often, a patient is considered to be terminally ill when the life expectancy is estimated to be six months or less, under the assumption that the disease will run its normal course. The six-month standard is arbitrary,cite web |url=http://www.ascensionhealth.org/ethics/public/issues/terminal.asp |title=Terminal Illness |accessdate=2008-02-09 |format= |work=] and best available estimates of longevity may be incorrect. Consequently, though a given patient may properly be considered terminal, this is not a guarantee that the patient will die within six months. Similarly, a patient with a slowly progressing disease, such as AIDS, may not be considered terminally ill because the best estimates of longevity were greater than six months. However this does not guarantee that the patient will not die unexpectedly early. In general, physicians slightly overestimate survival so that a person who is expected to live for about six weeks often dies about two weeks sooner than predicted.cite journal |author=Glare P, Virik K, Jones M, "et al" |title=A systematic review of physicians' survival predictions in terminally ill cancer patients |journal=BMJ |volume=327 |issue=7408 |pages=195–8 |year=2003 |pmid=12881260 |doi=10.1136/bmj.327.7408.195 |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=12881260]

Treatment

Some terminally ill patients stop all debilitating treatments to reduce unwanted side effects. Others continue aggressive treatment in the hope of an unexpected success. Still others reject conventional medical treatment and pursue unproven treatments such as radical dietary modifications. Patients' choices about different treatments may change over time.cite journal |author=Fried TR, O'leary J, Van Ness P, Fraenkel L |title=Inconsistency over time in the preferences of older persons with advanced illness for life-sustaining treatment |journal=Journal of the American Geriatrics Society |volume=55 |issue=7 |pages=1007–14 |year=2007 |pmid=17608872 |doi=10.1111/j.1532-5415.2007.01232.x]

Palliative care is normally offered to terminally ill patients, regardless of their overall disease management style, if it seems likely to help manage symptoms such as pain and improve quality of life. Hospice care, which can be provided at home or in a long-term care facility, additionally provides emotional and spiritual support for the patient and loved ones. Some complementary medicine approaches, such as relaxation therapy, [cite web | year=1996| title=Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. |work=NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia | publisher=The Journal of the American Medical Association (archives)| url=http://jama.ama-assn.org/cgi/content/abstract/276/4/313| accessmonthday=March 07 | accessyear=2006 ] massage, [cite web | author = Grealish L, Lomasney A, Whiteman B. |year=2000 | title=Foot massage. A nursing intervention to modify the distressing symptoms of pain and nausea in patients hospitalized with cancer (abstract). |publisher=PubMed, NCBI | url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=10851775&dopt=Abstract | accessmonthday=March 07 | accessyear=2006 ] and acupuncture [cite web | author= David Alimi et al. | title=Analgesic Effect of Auricular Acupuncture for Cancer Pain: A Randomized, Blinded, Controlled Trial | publisher=Journal of Clinical Oncology | year=2003 | url=http://www.jco.org/cgi/content/abstract/21/22/4120 | accessmonthday=March 07 | accessyear=2006 ] may relieve some symptoms and other causes of suffering.

Dying

Patients, healthcare workers, and recently bereaved family members often describe a "good death" in terms of effective choices made in a few areas:cite journal |author=Steinhauser K, Clipp E, McNeilly M, Christakis N, McIntyre L, Tulsky J |title=In search of a good death: observations of patients, families, and providers |journal=Ann Intern Med |volume=132 |issue=10 |pages=825–32 |year=2000 |pmid=10819707 | url=http://www.annals.org/cgi/content/full/132/10/825]

* Assurance of effective pain and symptom management
* Education about death and its aftermath, especially as it relates to decision-making
* Completion of any significant goals, such as resolving past conflicts

People who are terminally ill may or may not follow recognizable stages of grief.cite web |url=http://www.mayoclinic.com/health/grief/CA00041 |title=Terminal illness: Interacting with a terminally ill loved one - MayoClinic.com |accessdate=2008-02-09 |format= |work=] For example, a person who finds strength in denial may never reach a point of acceptance or accommodation and may react negatively to any statement that threatens this defense mechanism. Other people find comfort in meticulously arranging their financial and legal affairs or planning their funerals.

See also

* Anticipatory grief
* Do Not Resuscitate
* Euthanasia
* Interventionism
* Living will
* Inheritance of Hope

References