Abstract
Quality of life is a subjective concept, yet there have been some real and constructive attempts to measure the quality of a person's life so that meaningful comparisons can be made during treatment and as disease progresses. In this paper the multifaceted nature of quality of life is explored and the ways that the communication of healthcare professionals with a patient can dramatically influence the patient's sense of personal dignity and worth. Inherent in this are the relationships with the family, particularly with children in the family, who may suffer greatly in bereavement. Pressures on patients may make them feel a burden, as if they would be better off dead and certainly as if others may be better off without them still alive. This sense of being a burden is often behind requests for death hastening acts such as euthanasia. The fundamental difference between euthanasia and the cessation of futile treatments is also explored. The pivotal role of good communication is the route to ensuring that issues are addressed, with hope maintained for the patient to live as well as possible until they die, and that patients' quality of life is maximized.
References
Aaronson, N. K., Ahmedzai, S., Bergman, B., Bullinger, M., Cull, A., Duez, N. J., Filiberti, A., Flechtner, H., Fleishman, S. B., de Haes, J. C., et al. (1993). The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute85 (5): 365–376.Search in Google Scholar
Beauchamp, T. L. and Childress, J. (2001). Principles of Biomedical Ethics, 5th ed. New York: Oxford University Press.Search in Google Scholar
Breitbart, W., Rosenfeld, B., Pessin, H., Kaim, M., Funesti-Esch, J., Galietta, M., Nelson, C. J., and Brescia, R. (2000). Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. Journal of the American Medical Association284 (22): 2907–2911.Search in Google Scholar
Calman, K. C. (1984). Quality of life in cancer patients—an hypothesis. Journal of Medical Ethics10 (3): 124–127.Search in Google Scholar
Chochinov, H. M., Wilson, K. G., Enns, M., Mowchun, N., Lander, S., Levitt, M., and Clinch, J. J. (1995). Desire for death in the terminally ill. American Journal of Psychiatry152 (8): 1185–1191.Search in Google Scholar
Clark D. (2002). Between hope and acceptance: The medicalisation of dying. British Medical Journal324 (7342): 905–907.Search in Google Scholar
Ellershaw, J., Ward, C., and Neuberger, J. (2003). Care of the dying patient: The last hours or days of life—commentary: A “good death” is possible in the NHS. British Medical Journal326: 30–34.Search in Google Scholar
Emanuel, E. J., Fairclough, D. L., and Emanuel, L. L. (2000). Attitudes and desires related to euthanasia and physician-assisted suicide among terminally ill patients and their caregivers. Journal of the American Medical Association284 (19): 2460–2468.Search in Google Scholar
Finlay, I. G. and Sarangi, S. (forthcoming). Medical discourse, communication skills and terminally ill patients. In Encyclopaedia of Language and Linguistiscs, 2nd ed. New York: Elsevier.Search in Google Scholar
Ganzini, L., Nelson, H. D., Lee, M. A., Kraemer, D. F., Schmidt, T. A., and Delorit, M. A. (2001). Oregon physicians' attitudes about and experiences with end-of-life care since passage of the Oregon Death with Dignity Act. Journal of the American Medical Association285 (18): 2363–2369.Search in Google Scholar
Gillon, R. (1994). Medical ethics: Four principles plus attention to scope. British Medical Journal309 (6948): 184–188.Search in Google Scholar
Haverkate, I., van der Heide, A., Onwuteaka-Philipsen, B. D., van der Maas, P. J., and van der Wal, G. (2001). The emotional impact on physicians of hastening the death of a patient. Medical Journal of Australia175 (10): 519–522.Search in Google Scholar
Karnofsky, D. A. (1965). Problems and pitfalls in the evaluation of anticancer drugs. Cancer18 (12): 1517–1528.Search in Google Scholar
Kelly, B., Burnett, P., Pelusi, D., Badger, S., Varghese, F., and Robertson, M. (2002). Terminally ill cancer patients' wish to hasten death. Palliative Medicine16 (4): 339–345.Search in Google Scholar
Kissane, D. W. (2001). Demoralisation: Its impact on informed consent and medical care. Medical Journal of Australia175 (10): 537–539.Search in Google Scholar
Kissane, D. W., Street, A., and Nitschke, P. (1998). Seven deaths in Darwin: Case studies under the Rights of the Terminally Ill Act, Northern Territory, Australia. Lancet352 (9134): 1097–1102.Search in Google Scholar
Mak, Y. Y. W., Elwyn, G., and Finlay, I. G. (2003). Patients' voices are needed in debates on euthanasia. British Medical Journal327: 213–215.Search in Google Scholar
Pratheepawanit, N., Salek, M. S., Luscombe, D. K., and Finlay, I. G. (1998). Quality of life assessment in terminal care: Is it relevant?Pharmaceutical Journal261:R52.Search in Google Scholar
Saunders, C. (1987). The philosophy of terminal cancer care. Annals of the Academy of Medicine, Singapore16 (1): 151–154.Search in Google Scholar
Stott, N. C. and Davis, R. H. (1979). The exceptional potential in each primary care consultation. Journal of the Royal College of General Practitioners29 (201): 201–205.Search in Google Scholar
ten Have, H. A. (2001). Euthanasia: Moral paradoxes. Palliative Medicine15 (6): 505–511.Search in Google Scholar
Watt, H. (2001). Decisions relating to cardiopulmonary resuscitation. Commentary 3: Degrading lives?Journal of Medical Ethics27: 321–323.Search in Google Scholar
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