engleski

Paliative care and Informed Consent

Palliative care is directed to a patient during his/her terminal illness. Causal treatment is not possible in that time. However, a procedure that can largely contribute to raising quality of life is palliative care directed to alleviating specific symptoms: pain, heavy breathing, vomiting, etc. Palliative care deals, not only with physical symptoms, but especially with psychological and emotional problems of the patient, it helps with his spiritual orientation and in resolving problems that occur in the patient's community, related to the fact that he is soon to be gone. Palliative care helps the ones who care for the patient to overcome the loss.Basic principles of such an approach to the patient who is dying are respecting his will/autonomy, his personal dignity regardless of his culture, creed, nationality, race or financial state. In such an environment, the patient is able to reach free decisions considering informed consent or life will. Medical service, as any other service, should be priced and transparent in terms of what it consists and of the price of the treatment, only then can the patient decide will he or not accept it. Certain conditions should be met in order for the patient to reach a decision based on free will. Basic conditions for adequate decision making can be devised as follows: 1. Central (anthropocentric) accommodation of patients in palliative care. After a period in which the value of the individual was in the fact that he/she belonged to a community, after a period in which the patient was an object to numerous diagnostic and therapeutic procedures, a time has come to seek closer patient -doctor relation. 2. The way of bringing "bad news", and informing of reasons for a risky procedure and informed consent from the patient, must be suitable to the patient and the situation. 3. A condition for reaching an active relationship is understanding of the process in which the patient should cooperate. Medical professionals are obligated to explain it. 4. The main condition for an active relationship is that he/she trusts the physician that is asking for consent. Many persons sign informed consents, not because they are adequately informed of the procedure, but because of the trust they put in their doctors. 5. Patient must, also, have a wish to make decisions for himself, he/she must have such a personality. A large number of people, enjoy to be carried and lead through life, they do not want to know the truth. A far lesser number of people develops a personality that knows what he/she wants and wishes to be in charge of his/hers life. If the patient refuses to sign the consent, he/she should not be refused, instead, the procedures that are left should be carried out. Of course, a physician must be more adaptable than he/she is used to be. Generally, physicians are brought up for a paternalistic function: "I know what is best for you" (although it is often the case), because of his education and experience. If a patient refuses some forms of treatment (respirator, infusion), he should not be rejected, but helped within the frame of accepted treatments. Finally there is a financial factor, a patient refuses to cause additional costs, because of the family he/she is leaving behind. Unfortunately, this will be an argument that will more often continue to appear in the future. Because of the process of globalisation, presence of many cultures, races, religions, increased possibilities of their interaction and communication due to technology and media, the notion of what is "the best" for the patient became more relative and finally boils down to the subjective feeling of what is the best for a person. Who is protected by informed consent? Palliative movement and palliative medicine, with its holistic approach to the person that creates its own life, with its respect for the patient's consent, from visitors to nutrition and medical procedures includes informed consent as well as a part of the care for a terminally ill patient. A physician is here to make a suggestion. Patient is the one who will accept or refuse a suggestion made by a physician that he trusts. Of course, if the patient is not able to understand what is proposed to him due to various disorders (psychosis, dementia, etc.) his/hers family and the physician take that responsibility. The problem lies in the question, whereas they can or wish to make that decision morally and competently.Eventually, the patient is protected only by the clear conscience of a competent physician.

Paliative care; Informed Consent

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