”Someone Should Bring Up Death”

The initiative of legislation regarding euthanasia is making some professionals of terminal care dubious. In the opinion of the staff of Koivikko Home, the discussion of death and the decision of terminal care are delayed for too long.

MP Päivi Räsänen’s phone is ringing.
– Does terminal care mean that the patient is moved to a department’s storage room and they won’t be given anything to eat or drink, asked the caller.

The asker’s spouse had been informed about beginning the terminal care in the hospital. The same day the patient was moved to a leftover place in a storage room.

Räsänen used this example while speaking in a seminar concerning better terminal care instead of euthanasia. She has made an initiative of legislation so that patients will be ordained a right to terminal care regardless of where they live and what their disease is like.

The quality and availability of terminal care rose to be a matter of debate when the parliament received a citizen initiative for legalising euthanasia in Finland a couple of weeks ago. In Räsänen’s opinion, Finland needs a terminal care law instead of an euthanasia law.

The CEO of Hämeenlinna’s Koivikko Home, Riikka Koivisto, and nurse Kaija Karvonen agree with Räsänen. In their opinion, quality terminal care should become available to everyone before starting to discuss euthanasia.
– These days terminal care is available very unevenly depending on where you live, Karvonen says.

Riikka Koivisto reckons that behind the discussion of euthanasia underlies fear of pain, helplessness and suffering. Nobody wants a terrifying death.
– We should keep in mind that death can also be good, peaceful and gentle. There is no symptom that couldn’t be taken care of with the methods of modern terminal care, she says.

One poorly known and, in Koivisto’s opinion, too little used way of diminishing suffering is sedation, in other words putting one to light sleep.

It is used for handling pain, constant nausea, shortness of breath and sometimes anxiety if the approaching death feels overwhelming to deal with.
– Euthanasia is a frighteningly final solution. Unlike in euthanasia, in sedation a patient can be awakened if the symptoms ease off, Koivisto says.

If not, they can be let pass away peacefully when the time comes.

– At least I will have euthanasia if I end up in a wheelchair at some point.

This comment from a healthy person made Riikka Koivisto stop in her tracks some time ago. How can one ”have euthanasia”? To what extent should an individual’s right of self-determination stretch? Do people even know what they’re talking about when they talk about euthanasia?

Koivisto quietens to think about what makes a reasonable life. She has noticed that a human being adapts to many kinds of situations if they get a little time.

People aren’t constantly crying in the terminal care home either, and the patients don’t ask for assisted death. Instead, they want to spend time with their loved ones, watch TV, scratch the dog called Bono, who visits the department, and go to sauna if they have enough strength.

In Koivisto’s opinion, the debate on euthanasia measures our values and brings out faults in health care. Death is a pointlessly quietened subject and pushed to a distance in vain.
– Someone should bring up death, she says.

The decision on terminal care is always a difficult solution. It means ending the healing treatment and moving on to symptomatic treatment if there are no longer ways to control the disease. Karvonen and Koivisto emphasize that terminal care is also a form of active treatment and it gives the patient and their loved ones an opportunity to prepare for death.

A worse option is that the approach of death isn’t recognized and people don’t want to admit it, in which case neither terminal care nor symptomatic care will be provided. If the doctor only tells the patient that they’ll ”keep an eye on the situation”, they don’t necessarily even realize that death is near.
– The reception discussion of the terminal care department is often the first place where the word ’death’ is said out loud, nurse Kaija Karvonen says.

In Finland there are four terminal care homes: in Hämeenlinna, Helsinki, Turku and Tampere. Terminal care is given – or it could be given – also in specialised health care, the inpatient ward of health center and treatment institutes.

If the law on terminal care passed, it would mean at least these things in Koivisto and Karvonen’s opinion:

1. Discussions concerning death and terminal care between doctors and patients would increase.

2. Doctors’ training for that should be increased.

3. Nurses would be trained for terminal care. Now there’s only a a-few-hours-lasting course about death and it’s not about treating the dying patient, but handling the dead.

4. More and more people could die at home when the skills of home nursing would improve.

5. Terminal care would be provided in health centers’ inpatient wards, treatment institutes and special nursing all around Finland – not only in separate terminal care homes.

What would statutory terminal care cost, then?

The CEO of Koivikko-koti and the nurse ask to compare. At a health center’s inpatient ward one day costs approximately 200 euros, depending on the municipality. At a terminal care ward, the sum is 300 euros. In special health care the price is nearly 1000 euros.
– The most expensive part is when the ambulance comes to the ER. There begins a chain of expensive tests and X-rays that no longer benefit the patient in any way in the terminal care phase.

– All patients should be aware of a place to go to if the symptoms get worse, Karvonen emphasizes.

Glossary

Euthanasia: Doctor kills the patient intentionally by giving them drugs out of their repeated, voluntary and legally valid request.

Assisted suicide: Doctor assists the patient in suicide  by bringing them lethal drugs out of their request. The person must be able to take them by themselves.

Palliative care: Active overall (symptomatic) treatment that will be given when there’s no longer a chance for healing treatment.

Terminal care: Permitting death, in other words giving up treatments that sustain and prolong life when the patient no longer benefits from them and they rather bring more suffering.

Sedation: Lowering the patient’s state of consciousness (putting them to sleep), the purpose of which is to alleviate the kind of unbearable symptoms that cannot be controlled by any other treating methods.

This Is How It Goes Elsewhere

– Euthanasia is permitted in Belgium, Holland, Luxemburg and Columbia.

– Assisted suicide is permitted in Germany, Switzerland and in some of the states of the US.

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