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Terminally ill patients are people with physical disorders that are killing them. They may require life sustaining treatment or palliative care in addition to other medical, psychological and social forms of help.
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, 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, for example, a person who is expected to live for about six weeks would likely die around four weeks.
By definition, there is no cure or adequate treatment for terminal illnesses. However, some kinds of medical treatments may be appropriate anyway.
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.
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, massage, and acupuncture may relieve some symptoms and other causes of suffering.
Patients, healthcare workers, and recently bereaved family members often describe a good death in terms of effective choices made in a few areas:
- 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. 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.
- Advance directives
- Anticipatory grief
- Assisted suicide
- Do Not Resuscitate
- Home care
- Living will
- Palliative care
- Terminal cancer
References & Bibliography
- Terminal Illness. URL accessed on 2008-02-09.
- Glare P, Virik K, Jones M, et al. (2003). A systematic review of physicians' survival predictions in terminally ill cancer patients. BMJ 327 (7408): 195–8.
- Fried TR, O'leary J, Van Ness P, Fraenkel L (2007). Inconsistency over time in the preferences of older persons with advanced illness for life-sustaining treatment. Journal of the American Geriatrics Society 55 (7): 1007–14.
- (1996). Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia.. NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia. The Journal of the American Medical Association (archives). URL accessed on March 7 2006.
- Grealish L, Lomasney A, Whiteman B. (2000). Foot massage. A nursing intervention to modify the distressing symptoms of pain and nausea in patients hospitalized with cancer (abstract).. PubMed, NCBI. URL accessed on March 7 2006.
- David Alimi et al. (2003). Analgesic Effect of Auricular Acupuncture for Cancer Pain: A Randomized, Blinded, Controlled Trial. Journal of Clinical Oncology. URL accessed on March 7 2006.
- Steinhauser K, Clipp E, McNeilly M, Christakis N, McIntyre L, Tulsky J (May 2000). In search of a good death: observations of patients, families, and providers. Ann Intern Med 132 (10): 825–32.
- Terminal illness: Interacting with a terminally ill loved one - MayoClinic.com. URL accessed on 2008-02-09.
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