[Yeukai Mellary Chimpelo]

#92113

Which of these decision’s mentioned would you (or do you) personally find most challenging, and why?

Generally, the answer is all of the mentioned concepts. It stems from not having exposure or teaching to the different treatment plans. It stems from uncertainties and gaps in knowledge when it comes to the legalities and practicality of end of life care plans, it also stems from lack of protocols or lack of implementation of protocols on how to navigate this part of palliative care.

· Withholding or withdrawing life-sustaining treatments

This is one concept I grapple with whenever I’m faced with it. Some of to questions I struggle with would be:

– what is it to withhold care?
– how does one motivate or explain withholding care?
– what are the legalities around withholding care, what are the legislations around withdrawing care
– how does one broach the topic of WH/WD care with families and the patients (especially with those not known to a PC team, or worse where there’s no established PC team in that given institution
-how does one navigate a family member(s) or patient who is requesting care to be withheld or withdrawn
– importantly, how does one go about with drawing care. What are the steps. I understand it would be determined by the goals of care but even then…how does one do it safely?

· Discontinuing feeds at the end of life
– this is not something I don’t think I would struggle implementing because I understand the reasoning, I understand that even dying has its physiology
– what I struggle with is explaining it to family members, how would one explain this, would you leave it someone specialised in nutrition to explain?

· Do not attempt resuscitation (DNAR) or Allow Natural Death (AND)
– another gray area that is treated like taboo and so comes with great discomfort
– what is an DNAR vs an AND
– how does a family obtain one and when? (Especially when a team or person qualified to do so is not present)
– when is not appropriate to use or follow through with a DNAR or AND
– when is appropriate to not follow through with a DNAR or AND?

· Using sedation at the end of life
– I guess here, it’s more of a question of why not?
– when would it be problematic to use sedation?
– how does one examine a patient who is sedated and hence for how do you manage them appropriately
– also, how do you navigate the complications of sedation

In closing, my struggle with these concepts are secondary to not understanding the mechanisms of these constructs. Not seeing PC being practised in space where they should be adds to this discomfort and challenging. Not all questions can be asked but where can one source the information or expertise to understand better?

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