Question

Answer of the following questions (one paragraph per question).

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How do the goals of care change when the patient’s condition is recognized as terminal?

• How can patients be helped to maintain control over the end of their lives?

• How should doctors respond to requests from relatives to keep information from the patient?

Answer 1

The goal of care for any kind of the patient from the health care team would be to diagnose their disease condition, to identify the cure and to treat them in order to improve their health status. But, once recognized of patient being as terminally ill all the goals and interventions changes accordingly. The goals of patient care will be focusing more on maximizing the patient's quality of life, to make his remaining days free from pain and sufferings. The physicians as well as the nursing staffs plan goal for such patient by empathising them. The goal will focus more on patient and family's psychological and emotional aspects and on how to deal with it. The patients are provided with all kinds of therapies and making them happy and satisfied. Also involving their family members in discussing about their goals is one of the major change that occurs when the patient becomes terminally ill.

- towards the end of his life, patient completely trusts the health care providers dealing with his case and supporting and encouraging him throughout. Patients can be helped to maintain control over the end of their lives with the support of those health care providers. They can support him in various different aspects. First of all, the health care providers should be true to him about all the informational given to him related to his condition. In this way the patient will be prepared for the future results. Secondly, the proper communication and counselling to the patient along with his family members is very important. This will help the patient to stabilise their emotional fear about the encounter with his death as well as about the family's concern and emotional condition after his death will be understood. This will help them to ease their emotional pain. Lastly, the patient should be provided with the ray of hope. It is very important for the health care providers to be optimistic but they should be realistic. If the patient is provided with positivity then it will help them to make an effort to be happy and to fight with the disease.

- the most difficult situation for a physician is to choose between his duty or the emotion of the patient's family members. But, in such situations, when the doctor is requested from the relatives of the patient to keep the information from him, the doctor should always follow his duty and politely talk about the consequences that may occur because of keeping the information from the patient. He completely has a right to know about all his conditions be it good or bad and has a full right to choose if to involve his family members or not to provide the information. If the patient knows about his condition priorly, he will be able to understand his situations and be ready for all the future challenges that he might come across. He can get treatments and therapies with a positive thinking and can be optimistic about his betterment. He can involve himself in planning goals and interventions meant for him and can be satisfied with all the curiosities that he might have within him.

Hence, in my opinion, informing the patient about his condition is lawfully and dutifully considered to be fair and virtuous.