End of life

Made Metu Bayu Kubera (20710047)

Lecturer : dr. Meivy Isnoviana, S.H., M.H.
Introduction
The end of life phase occurs through a stage of the process ranging from
the decrease in the physical, psychosocial, and spiritual conditions of the
patient to the eventual death. Patients with the condition will need more
intensive care, long treatment times, and specialized medications. The
complexity of the problems experienced by patients in the end of life phase
gives a special burden to the families directly involved in the treatment
because the patient needs a total treatment for 24 hours. If this stressor
lasts a long time, it can elicit an emotional response. The most common
emotional response is anxiety.

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 CASE
Let’s start with the first set of slides
 “
Kate is a 51-year-old woman with terminal ovarian cancer. She is a single
mother with five children aged 24, 23, 17, 15 and 11. She is also the
guardian for her 13-year-old granddaughter. Kate was diagnosed with
advanced ovarian cancer just months after her daughter's death and
referred to the palliative care team. At first she agreed to only see a
specialist nurse. However, after a few months some financial and legal
issues arose regarding the children so Kate agreed to see a palliative care
social worker. Luckily this was the same team member she saw after her
daughter's death and who she remembers helping out at the time.

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CONTINUED…

Slowly, Kate agreed to the social worker's visit and she gradually built a
relationship with Kate and her eldest daughter Louise, her primary carer and
babysitting her younger siblings. Kate introduced social workers to younger
children and the worker was able to support Kate in discussions about her
illness, death and dying and the future. With Kate's permission she can also
work with children's schools, providing support and advice to teaching staff.
Weekly calls and regular visits continued for nearly a year. Kate deteriorated
gradually and became weaker, but she remained determined to be there for her
children and ensured they would be looked after once she left

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CONTINUED…

Palliative care social workers were able to explain the role of all involved to the
family and although they were still worried, the first visit went smoothly. After one
more visit, the assessor closed the case reporting that the children were well cared
for and Louise would be the most appropriate person to care for them in the future. 
As Kate's condition worsened, the palliative care team began discussing with her
where she wanted to die. Kate wants to be at home for as long as possible but wants
to go to the hospital for her last few days because she doesn't want to die at home in
front of her children. This is noted in previous decisions. Kate recently called the
team and said she felt very unwell and tired and she wanted to come to the hospital
because she thought she was going to die.

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FINALLY…

Kate arrived on Friday and looked relaxed as soon as she arrived. He died peacefully
two days later with family around him. Palliative care social workers met louise and
the smaller children the day after Kate's death. Initially the family will need support
with practical issues such as Kate's funeral and the transfer of allowances on Louise's
behalf. The children have all helped arrange funerals and all their schools have been
notified. The grief support from the team will continue for as long as it takes but at the
moment her family are relatively well, slowly accepting Kate's death, all knowing they
are following her wishes, doing all they can to support her and be with her when she
dies.

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 CASE
ANALYSI  BASIC BIOETHICAL
 4 BOX METHOD

S  ORDINARY AND
EXTRAORDINARY

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 BASIC BIOETHICAL :
In the above cases, ethical dilemmas or moral basic rules that stand
out in the above cases are:

 Otonomy : respects the rights of patients seen from Kate's request to

die in hospital and does not want to be seen by her children and
grandchildren. This is noted in previous decisions.

 Non maleficence : directs patients to palliative therapy in order to

provide life expectancy as usual and provide education and
information about palliative therapy. Even if the patient will still die.

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 4 BOX METHOD
Medical Indications Patient Preferences

 Kate is a 51-year-old woman with terminal ovarian  At first she agreed to only see a specialist
cancer
 Kate was diagnosed with advanced ovarian
cancer just months after her daughter's death and
referred to the palliative care team
nurse. However, after a few months some financial
and legal issues arose regarding the children so
Kate agreed to see a palliative care social worker
 As Kate's condition worsened, the palliative care
team began discussing with her where she wanted
to die. Kate wants to be at home for as long as
possible but wants to go to the hospital for her last
few days because she doesn't want to die at home in
front of her children. This is noted in previous
decisions

Quality of life Contextual Features

 Kate's prognosis remains to die peacefully.
 Health factors in the patient, the main influence for the
patient's life.
 Economic factors that influence the selection of therapy.
 Factor in the patient's anxiety towards his children and
grandchildren 

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 Ordinary and Extraordinary

In the above cases including extraordinary because, the 51-year-

old patient with late-stage ovarian cancer with a very unhealthy
and tired state and she wanted to come to the hospital because
she thought she was going to die. The patient arrived on Friday
and looked relaxed as soon as he arrived and without any medical
treatment from the patient's palliative care officer died peacefully
two days later with family around him.

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CONCLUSION
NOW !

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In the journal above it is said that the anxiety experienced by the family while
accompanying the patient in the end of life phase is the feeling of anxiety about the loss
of a loved one. Anxiety responses shown by families are both physical and psychological
responses. Thus, the meaning obtained from this study is in anxiety in accompanying
patients in the end of life phase.

In the above cases palliative therapy requires a good psychological and physical to
undergo such treatment. The need for support and trust from patients and families must
still be provided during treatment so that the patient can feel life without feeling anxious
and not thinking about the life that has not been resolved by him until the end of the day
and feel peace when god calls.

The relationship between end of life and palliative therapy is very close that must be had
by the patient and the family is self-control from anxiety will be left behind or leave a
loved family and a good physical family from the family in order to undergo therapy
properly until the patient feels a peace of life.13And time will go on slowly will accept death
THANKS!

Any questions?

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 MAPS

DAFTAR PUSTAKA :
our office

1. lestari,dkk.2020.Study Fenomenologi: Psikologis Pasien Kanker Yang

Menjalani Kemoterapi.Jurnal Keperawatan Suaka Insan.Volume 5 Edisi I.Juni
2020.

2. https://www.scie.org.uk/adults/endoflifecare/ideasforpractice/holisticpalliativec
are.asp

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