Terminal illness - Wikipedia

Terminal illness or end-stage disease is a disease that cannot be cured or adequately treated and is reasonably expected to result in the death of the ... Terminalillness FromWikipedia,thefreeencyclopedia Jumptonavigation Jumptosearch Incurablefataldisease Thisarticleisaboutfataldiseases.Forthealternativedefinitionofeyestrain,seecomputervisionsyndrome.Forotheruses,seeTerminal. Terminalillnessorend-stagediseaseisadiseasethatcannotbecuredoradequatelytreatedandisreasonablyexpectedtoresultinthedeathofthepatient.Thistermismorecommonlyusedforprogressivediseasessuchascancer,dementiaoradvancedheartdiseasethanforinjury.Inpopularuse,itindicatesadiseasethatwillprogressuntildeathwithnearabsolutecertainty,regardlessoftreatment.Apatientwhohassuchanillnessmaybereferredtoasaterminalpatient,terminallyillorsimplyasbeingterminal.Thereisnostandardizedlifeexpectancyforapatienttobeconsideredterminal,althoughitisgenerallymonthsorless.Lifeexpectancyforterminalpatientsisaroughestimategivenbythephysicianbasedonpreviousdataanddoesnotalwaysreflecttruelongevity.[1]Anillnesswhichislifelongbutnotfatalisachroniccondition. Terminalpatientshaveoptionsfordiseasemanagementafterdiagnosis.Examplesincludecaregiving,continuedtreatment,hospicecare,andphysician-assistedsuicide.Decisionsregardingmanagementaremadebythepatientandhisorherfamily,althoughmedicalprofessionalsmaygiverecommendationsormoreabouttheservicesavailabletoterminalpatients.[2][3] Lifestyleafterdiagnosisvariesdependinglargelyonmanagementdecisionsandalsothenatureofthedisease,andtheremaybelivingrestrictionsdependingontheconditionofthepatient.Oftentimes,terminalpatientsmayexperiencedepressionoranxietyassociatedwithoncomingdeath,andfamilyandcaregiversmaystrugglewithpsychologicalburdensaswell.Psycho-therapeuticinterventionsmayhelpalleviatesomeoftheseburdens,andisoftenincorporatedinpalliativecare.[2][4] Becauseterminalpatientsareawareoftheironcomingdeaths,theyhavemoretimetoprepareadvancecareplanning,suchasadvancedirectivesandlivingwills,whichhavebeenshowntoimproveend-of-lifecare.Whiledeathcannotbeavoided,patientscanstillstrivetodieagooddeath.[5][6][7] Contents 1Management 1.1Caregiving 1.2Palliativecare 1.3Hospicecare 1.4Medicationsforterminalpatients 1.5Continuedtreatment 1.6Transplant 1.7Physician-assistedsuicide 2Medicalcare 2.1Doctor–patientrelationships 2.2Mortalitypredictions 2.3Healthcarespending 3Psychologicalimpact 3.1Impactonpatient 3.2Copingforpatients 3.3Impactonfamily 3.4Copingforfamily 4Dying 4.1AdvanceDirectives 4.2Do-not-resuscitate 4.3Symptomsneardeath 4.4Gooddeath 5Seealso 6References 7Furtherreading Management[edit] Mainarticle:End-of-lifecare Bydefinition,thereisnotacureoradequatetreatmentforterminalillnesses.However,somekindsofmedicaltreatmentsmaybeappropriateanyway,suchastreatmenttoreducepainoreasebreathing.[8] Someterminallyillpatientsstopalldebilitatingtreatmentstoreduceunwantedsideeffects.Otherscontinueaggressivetreatmentinthehopeofanunexpectedsuccess.Stillothersrejectconventionalmedicaltreatmentandpursueunproventreatmentssuchasradicaldietarymodifications.Patients'choicesaboutdifferenttreatmentsmaychangeovertime.[9] Palliativecareisnormallyofferedtoterminallyillpatients,regardlessoftheiroveralldiseasemanagementstyle,ifitseemslikelytohelpmanagesymptomssuchaspainandimprovequalityoflife.Hospicecare,whichcanbeprovidedathomeorinalong-termcarefacility,additionallyprovidesemotionalandspiritualsupportforthepatientandlovedones.Somecomplementaryapproaches,suchasrelaxationtherapy,massage,andacupuncturemayrelievesomesymptomsandothercausesofsuffering.[10][11][12][13] Caregiving[edit] Terminalpatientsoftenneedacaregiver,whocouldbea nurse,licensedpracticalnurseorafamilymember.Caregiverscanhelppatientsreceivemedicationstoreducepainandcontrolsymptomsof nausea or vomiting.Theycanalsoassisttheindividualwithdailylivingactivitiesandmovement.Caregiversprovideassistancewithfoodand psychological supportandensurethattheindividualiscomfortable.[14] Thepatient'sfamilymayhavequestionsandmostcaregiverscanprovideinformationtohelpeasethemind.Doctorsgenerallydonotprovideestimatesforfearofinstillingfalsehopesorobliterateanindividual'shope.[15] Inmostcases,thecaregiverworksalongwithphysiciansandfollowsprofessionalinstructions.Caregiversmaycallthephysicianoranurseiftheindividual: experiencesexcessivepain. isindistressorhavingdifficultybreathing. hasdifficultypassingurineorisconstipated. hasfallenandappearshurt. isdepressedandwantstoharmthemselves. refusestotakeprescribedmedications,raisingethicalconcernsbestaddressedbyapersonwithmoreextensiveformaltraining. orifthecaregiverdoesnotknowhowtohandlethesituation. Mostcaregiversbecomethepatient'slistenersandlettheindividualexpressfearsandconcernswithoutjudgment.Caregiversreassurethepatientandhonoralladvancedirectives.Caregiversrespecttheindividual'sneedforprivacyandusuallyholdallinformationconfidential.[16][17] Palliativecare[edit] Palliativecarefocusesonaddressingpatients'needsafterdiseasediagnosis.Whilepalliativecareisnotdiseasetreatment,itaddressespatients'physicalneeds,suchaspainmanagement,offersemotionalsupport,caringforthepatientpsychologicallyandspiritually,andhelpspatientsbuildsupportsystemsthatcanhelpthemgetthroughdifficulttimes.Palliativecarecanalsohelppatientsmakedecisionsandcometounderstandwhattheywantregardingtheirtreatmentgoalsandqualityoflife.[18] Palliativecareisanattempttoimprovepatients'quality-of-lifeandcomfort,andalsoprovidesupportforfamilymembersandcarers.[19]Additionally,itlowershospitaladmissionscosts.However,needsforpalliativecareareoftenunmetwhetherduetolackofgovernmentsupportandalsopossiblestigmaassociatedwithpalliativecare.Forthesereasons,theWorldHealthAssemblyrecommendsdevelopmentofpalliativecareinhealthcaresystems.[2] Palliativecareandhospicecareareoftenconfused,andtheyhavesimilargoals.However,hospicecareisspecificallyforterminalpatientswhilepalliativecareismoregeneralandofferedtopatientswhoarenotnecessarilyterminal.[20][18] Hospicecare[edit] Whilehospitalsfocusontreatingthedisease,hospicesfocusonimprovingpatientquality-of-lifeuntildeath.Acommonmisconceptionisthathospicecarehastensdeathbecausepatients"giveup"fightingthedisease.However,patientsinhospicecareoftenlivethesamelengthoftimeaspatientsinthehospital.Astudyof3850livercancerpatientsfoundthatpatientswhoreceivedhospicecare,andthosewhodidnot,survivedforthesameamountoftime.Infact,astudyof3399adultlungcancerpatientsshowedthatpatientswhoreceivedhospicecareactuallysurvivedlongerthanthosewhodidnot.Additionally,inbothofthesestudies,patientsreceivinghospicecarehadsignificantlylowerhealthcareexpenditures.[21][22] Hospicecareallowspatientstospendmoretimewithfamilyandfriends.Sincepatientsareinthecompanyofotherhospicepatients,theyhaveanadditionalsupportnetworkandcanlearntocopetogether.Hospicepatientsarealsoabletoliveatpeaceawayfromahospitalsetting;theymayliveathomewithahospiceproviderorataninpatienthospicefacility.[18] Medicationsforterminalpatients[edit] Terminalpatientsexperiencingpain,especiallycancer-relatedpain,areoftenprescribedopioidstorelievesuffering.Thespecificmedicationprescribed,however,willdifferdependingonseverityofpainanddiseasestatus.[23] Thereexistinequitiesinavailabilityofopioidstoterminalpatients,especiallyincountrieswhereopioidaccessislimited.[2] Acommonsymptomthatmanyterminalpatientsexperienceisdyspnea,ordifficultywithbreathing.Toeasethissymptom,doctorsmayalsoprescribeopioidstopatients.Somestudiessuggestthatoralopioidsmayhelpwithbreathlessness.However,duetolackofconsistentreliableevidence,itiscurrentlyunclearwhethertheytrulyworkforthispurpose.[24] Dependingonthepatient'scondition,othermedicationswillbeprescribedaccordingly.Forexample,ifpatientsdevelopdepression,antidepressantswillbeprescribed.Anti-inflammationandanti-nauseamedicationsmayalsobeprescribed.[25] Continuedtreatment[edit] Someterminalpatientsopttocontinueextensivetreatmentsinhopeofamiraclecure,whetherbyparticipatinginexperimentaltreatmentsandclinicaltrialsorseekingmoreintensetreatmentforthedisease.Ratherthanto"giveupfighting,"patientsspendthousandsmoredollarstotrytoprolonglifebyafewmoremonths.Whatthesepatientsoftendogiveup,however,isqualityoflifeattheendoflifebyundergoingintenseandoftenuncomfortabletreatment.Ameta-analysisof34studiesincluding11,326patientsfrom11countriesfoundthatlessthanhalfofallterminalpatientscorrectlyunderstoodtheirdiseaseprognosis,orthecourseoftheirdiseaseandlikelinessofsurvival.Thiscouldinfluencepatientstopursueunnecessarytreatmentforthediseaseduetounrealisticexpectations.[18][26] Transplant[edit] Forpatientswithendstagekidneyfailure,studieshaveshownthattransplantsincreasethequalityoflifeanddecreasesmortalityinthispopulation.Inordertobeplacedontheorgantransplantlist,patientsarereferredandassessedbasedoncriteriathatrangesfromcurrentcomorbiditiestopotentialfororganrejectionposttransplant.Initialscreeningmeasuresinclude:bloodtests,pregnancytests,serologictests,urinalysis,drugscreening,imaging,andphysicalexams.[27][28][29] Forpatientswhoareinterestedinlivertransplantation,patientswithacuteliverfailurehavethehighestpriorityoverpatientswithonlycirrhosis.[30]Acuteliverfailurepatientswillpresentwithworseningsymptomsofsomnolenceorconfusion(hepaticencephalopathy)andthinnerblood(increasedINR)duetotheliver'sinabilitytomakeclottingfactors.[31]Somepatientscouldexperienceportalhypertension,hemorrhages,andabdominalswelling(ascites).ModelforEndStageLiverDisease(MELD)isoftenusedtohelpprovidersdecideandprioritizecandidatesfortransplant.[32] Physician-assistedsuicide[edit] Physician-assistedsuicide(PAS)ishighlycontroversial,andlegalinonlyafewcountries.InPAS,physicians,withvoluntarywrittenandverbalconsentfromthepatient,givepatientsthemeanstodie,usuallythroughlethaldrugs.Thepatientthenchoosesto"diewithdignity,"decidingonhis/herowntimeandplacetodie.ReasonsastowhypatientschoosePASdiffer.Factorsthatmayplayintoapatient'sdecisionincludefuturedisabilityandsuffering,lackofcontroloverdeath,impactonfamily,healthcarecosts,insurancecoverage,personalbeliefs,religiousbeliefs,andmuchmore.[3] PASmaybereferredtoinmanydifferentways,suchasaidindying,assisteddying,deathwithdignity,andmanymore.Theseoftendependontheorganizationandthestancetheytakeontheissue.Inthissectionofthearticle,itwillbereferredtoasPASforthesakeofconsistencywiththepre-existingWikipediapage:AssistedSuicide. IntheUnitedStates,PASormedicalaidindyingislegalinselectstates,includingOregon,Washington,Montana,Vermont,andNewMexico,andtherearegroupsbothinfavorofandagainstlegalization.[33] SomegroupsfavorPASbecausetheydonotbelievetheywillhavecontrolovertheirpain,becausetheybelievetheywillbeaburdenontheirfamily,andbecausetheydonotwanttoloseautonomyandcontrolovertheirownlivesamongotherreasons.TheybelievethatallowingPASisanactofcompassion.[34] Whilesomegroupsbelieveinpersonalchoiceoverdeath,othersraiseconcernsregardinginsurancepoliciesandpotentialforabuse.AccordingtoSulmasyetal.,themajornon-religiousargumentsagainstphysician-assistedsuicidearequotedasfollows: (1)"itoffendsme",suicidedevalueshumanlife; (2)slipperyslope,thelimitsoneuthanasiagraduallyerode; (3)"paincanbealleviated",palliativecareandmoderntherapeuticsmoreandmoreadequatelymanagepain; (4)physicianintegrityandpatienttrust,participatinginsuicideviolatestheintegrityofthephysicianandunderminesthetrustpatientsplaceinphysicianstohealandnottoharm"[35] Again,therearealsoargumentsthatthereareenoughprotectionsinthelawthattheslipperyslopeisavoided.Forexample,theDeathwithDignityActinOregonincludeswaitingperiods,multiplerequestsforlethaldrugs,apsychiatricevaluationinthecaseofpossibledepressioninfluencingdecisions,andthepatientpersonallyswallowingthepillstoensurevoluntarydecision.[36] PhysiciansandmedicalprofessionalsalsohavedisagreeingviewsonPAS.Somegroups,suchastheAmericanCollegeofPhysicians(ACP),theAmericanMedicalAssociation(AMA),theWorldHealthOrganization,AmericanNursesAssociation,HospiceNursesAssociation,AmericanPsychiatricAssociation,andmorehaveissuedpositionstatementsagainstitslegalization.[37][34][38] TheACP'sargumentconcernsthenatureofthedoctor-patientrelationshipandthetenetsofthemedicalprofession.TheystatethatinsteadofusingPAStocontroldeath:"throughhigh-qualitycare,effectivecommunication,compassionatesupport,andtherightresources,physicianscanhelppatientscontrolmanyaspectsofhowtheyliveoutlife'slastchapter."[34] OthergroupssuchastheAmericanMedicalStudentsAssociation,theAmericanPublicHealthAssociation,theAmericanMedicalWomen'sAssociation,andmoresupportPASasanactofcompassionforthesufferingpatient.[33] Inmanycases,theargumentonPASisalsotiedtoproperpalliativecare.TheInternationalAssociationforHospiceandPalliativeCareissuedapositionstatementarguingagainstconsideringlegalizingPASunlesscomprehensivepalliativecaresystemsinthecountrywereinplace.Itcouldbearguedthatwithproperpalliativecare,thepatientwouldexperiencefewerintolerablesymptoms,physicaloremotional,andwouldnotchoosedeathoverthesesymptoms.PalliativecarewouldalsoensurethatpatientsreceiveproperinformationabouttheirdiseaseprognosisasnottomakedecisionsaboutPASwithoutcompleteandcarefulconsideration.[39] Medicalcare[edit] Manyaspectsofmedicalcarearedifferentforterminalpatientscomparedtopatientsinthehospitalforotherreasons. Doctor–patientrelationships[edit] Doctor–patientrelationshiparecrucialinanymedicalsetting,andespeciallysoforterminalpatients.Theremustbeaninherenttrustinthedoctortoprovidethebestpossiblecareforthepatient.Inthecaseofterminalillness,thereisoftenambiguityincommunicationwiththepatientabouthis/hercondition.Whileterminalconditionprognosisisoftenagravematter,doctorsdonotwishtoquashallhope,foritcouldunnecessarilyharmthepatient'smentalstateandhaveunintendedconsequences.However,beingoverlyoptimisticaboutoutcomescanleavepatientsandfamiliesdevastatedwhennegativeresultsarise,asisoftenthecasewithterminalillness.[26] Mortalitypredictions[edit] Often,apatientisconsideredterminallyillwhenhisorherestimatedlifeexpectancyissixmonthsorless,undertheassumptionthatthediseasewillrunitsnormalcoursebasedonpreviousdatafromotherpatients.Thesix-monthstandardisarbitrary,andbestavailableestimatesoflongevitymaybeincorrect.Thoughagivenpatientmayproperlybeconsideredterminal,thisisnotaguaranteethatthepatientwilldiewithinsixmonths.Similarly,apatientwithaslowlyprogressingdisease,suchasAIDS,maynotbeconsideredterminallyillifthebestestimateoflongevityisgreaterthansixmonths.However,thisdoesnotguaranteethatthepatientwillnotdieunexpectedlyearly.[40] Ingeneral,physiciansslightlyoverestimatethesurvivaltimeofterminallyillcancerpatients,sothat,forexample,apersonwhoisexpectedtoliveforaboutsixweekswouldlikelydiearoundfourweeks.[41] Arecentsystematicreviewonpalliativepatientsingeneral,ratherthanspecificallycancerpatients,statesthefollowing:"Accuracyofcategoricalestimatesinthissystematicreviewrangedfrom23%upto78%andcontinuousestimatesover-predictedactualsurvivalby,potentially,afactoroftwo."Therewasnoevidencethatanyspecifictypeofclinicianwasbetteratmakingthesepredictions.[42] Healthcarespending[edit] Healthcareduringthelastyearoflifeiscostly,especiallyforpatientswhousedhospitalservicesoftenduringend-of-life.[43] Infact,accordingtoLangtonetal.,therewere"exponentialincreasesinserviceuseandcostsasdeathapproached."[44] Manydyingterminalpatientsarealsobroughttotheemergencydepartment(ED)attheendoflifewhentreatmentisnolongerbeneficial,raisingcostsandusinglimitedspaceintheED.[45] Whilethereareoftenclaimsabout"disproportionate"spendingofmoneyandresourcesonend-of-lifepatients,datahavenotproventhistypeofcorrelation.[46] Thecostofhealthcareforend-of-lifepatientsis13%ofannualhealthcarespendingintheU.S.However,ofthegroupofpatientswiththehighesthealthcarespending,end-of-lifepatientsonlymadeup11%ofthesepeople,meaningthemostexpensivespendingisnotmadeupmostlyofterminalpatients.[47] Manyrecentstudieshaveshownthatpalliativecareandhospiceoptionsasanalternativearemuchlessexpensiveforend-of-lifepatients.[21][22][20] Psychologicalimpact[edit] Copingwithimpendingdeathisahardtopictodigestuniversally.Patientsmayexperiencegrief,fear,loneliness,depression,andanxietyamongmanyotherpossibleresponses.Terminalillnesscanalsolendpatientstobecomemorepronetopsychologicalillnesssuchasdepressionandanxietydisorders.Insomniaisacommonsymptomofthese.[4] Itisimportantforlovedonestoshowtheirsupportforthepatientduringthesetimesandtolistentohisorherconcerns.[48] Peoplewhoareterminallyillmaynotalwayscometoaccepttheirimpendingdeath.Forexample,apersonwhofindsstrengthin denial mayneverreachapointofacceptanceoraccommodationandmayreactnegativelytoanystatementthatthreatensthis defensemechanism.[48] Impactonpatient[edit] Depressionisrelativelycommonamongterminalpatients,andtheprevalenceincreasesaspatientsbecomesicker.Depressioncausesqualityoflifetogodown,andasizableportionofpatientswhorequestassistedsuicidearedepressed.Thesenegativeemotionsmaybeheightenedbylackofsleepandpainaswell.Depressioncanbetreatedwithantidepressantsand/ortherapy,butdoctorsoftendonotrealizetheextentofterminalpatients'depression.[4] Becausedepressioniscommonamongterminalpatients,theAmericanCollegeofPhysiciansrecommendsregularassessmentsfordepressionforthispopulationandappropriateprescriptionofantidepressants.[6] Anxietydisordersarealsorelativelycommonforterminalpatientsastheyfacetheirmortality.Patientsmayfeeldistressedwhenthinkingaboutwhatthefuturemayhold,especiallywhenconsideringthefutureoftheirfamiliesaswell.Itisimportanttonote,however,thatsomepalliativemedicationsmayfacilitateanxiety.[4] Copingforpatients[edit] Caregiversmaylistentotheconcernsofterminalpatientstohelpthemreflectontheiremotions.Differentformsofpsychotherapyandpsychosocialintervention,whichcanbeofferedwithpalliativecare,mayalsohelppatientsthinkaboutandovercometheirfeelings.AccordingtoBlock,"mostterminallyillpatientsbenefitfromanapproachthatcombinesemotionalsupport,flexibility,appreciationofthepatient’sstrengths,awarmandgenuinerelationshipwiththetherapist,elementsoflife-review,andexplorationoffearsandconcerns."[4] Impactonfamily[edit] Terminalpatients'familiesoftenalsosufferpsychologicalconsequences.Ifnotwellequippedtofacetherealityoftheirlovedone'sillness,familymembersmaydevelopdepressivesymptomsandevenhaveincreasedmortality.Takingcareofsickfamilymembersmayalsocausestress,grief,andworry.Additionally,financialburdenfrommedicaltreatmentmaybeasourceofstress.[2] Copingforfamily[edit] Discussingtheanticipatedlossandplanningforthefuturemayhelpfamilymembersacceptandprepareforthepatient'sdeath.Interventionsmayalsobeofferedforanticipatorygrief.Inthecaseofmoreseriousconsequencessuchasdepression,amoreseriousinterventionortherapyisrecommended.[17] Griefcounselingandgrieftherapymayalsoberecommendedforfamilymembersafteralovedone'sdeath.[49] Dying[edit] Whendying,patientsoftenworryabouttheirqualityoflifetowardstheend,includingemotionalandphysicalsuffering.[3] Inorderforfamiliesanddoctorstounderstandclearlywhatthepatientwantsforthemselves,itisrecommendedthatpatients,doctors,andfamiliesallconveneanddiscussthepatient'sdecisionsbeforethepatientbecomesunabletodecide.[5][6][50] AdvanceDirectives[edit] Attheendoflife,especiallywhenpatientsareunabletomakedecisionsontheirownregardingtreatment,itisoftenuptofamilymembersanddoctorstodecidewhattheybelievethepatientswouldhavewantedregardingtheirdeaths,whichisoftenaheavyburdenandhardforfamilymemberstopredict.Anestimated25%ofAmericanadultshaveanadvancedirective,meaningthemajorityofAmericansleavethesedecisionstobemadebyfamily,whichcanleadtoconflictandguilt.Althoughitmaybeadifficultsubjecttobroach,itisimportanttodiscussthepatient'splansforhowfartocontinuetreatmentshouldtheybecomeunabletodecide.Thismustbedonewhilethepatientisstillabletomakethedecisions,andtakestheformofanadvancedirective.Theadvancedirectiveshouldbeupdatedregularlyasthepatient'sconditionchangessoastoreflectthepatient'swishes.[51][17] Someofthedecisionsthatadvancedirectivesmayaddressincludereceivingfluidsandnutritionsupport,gettingbloodtransfusions,receivingantibiotics,resuscitation(iftheheartstopsbeating),andintubation(ifthepatientstopsbreathing).[49] Havinganadvancedirectivecanimproveend-of-lifecare.[50] Itishighlyrecommendedbymanyresearchstudiesandmeta-analysesforpatientstodiscussandcreateanadvancedirectivewiththeirdoctorsandfamilies.[5][50][6] Do-not-resuscitate[edit] Mainarticle:Donotresuscitate Oneoftheoptionsofcarethatpatientsmaydiscusswiththeirfamiliesandmedicalprovidersisthedo-not-resuscitate(DNR)order.Thismeansthatifthepatient'sheartstops,CPRandothermethodstobringbackheartbeatwouldnotbeperformed.Thisisthepatient'schoicetomakeandcandependonavarietyofreasons,whetherbasedonpersonalbeliefsormedicalconcerns.DNRorderscanbemedicallyandlegallybindingdependingontheapplicablejurisdiction.[52] Decisionsliketheseshouldbeindicatedintheadvancedirectivesothatthepatient'swishescanbecarriedouttoimproveend-of-lifecare.[51] Symptomsneardeath[edit] Avarietyofsymptomsbecomemoreapparentwhenapatientisnearingdeath.Recognizingthesesymptomsandknowingwhatwillcomemayhelpfamilymembersprepare.[49] Duringthefinalfewweeks,symptomswillvarylargelydependingonthepatient'sdisease.Duringthefinalhours,patientsusuallywillrejectfoodandwaterandwillalsosleepmore,choosingnottointeractwiththosearoundthem.Theirbodiesmaybehavemoreirregularly,withchangesinbreathing,sometimeswithlongerpausesbetweenbreaths,irregularheartrate,lowbloodpressure,andcoldnessintheextremities.Itisimportanttonote,however,thatsymptomswillvaryperpatient.[53] Gooddeath[edit] Patients,healthcareworkers,andrecentlybereavedfamilymembersoftendescribea"gooddeath"intermsofeffectivechoicesmadeinafewareas:[54] Assuranceofeffectivepainandsymptommanagement. Educationaboutdeathanditsaftermath,especiallyasitrelatestodecision-making. Completionofanysignificantgoals,suchasresolvingpastconflicts.[7] Inthelasthoursoflife,palliativesedationmayberecommendedbyadoctororrequestedbythepatienttoeasethesymptomsofdeathuntilheorshepassesaway.Palliativesedationisnotintendedtoprolonglifeorhastendeath;itismerelymeanttorelievesymptoms.[55] Seealso[edit] Advancehealthcaredirective Anticipatorygrief Donotresuscitate End-of-lifecare Euthanasia HospicecareintheUnitedStates Interventionism(medicine) LiverpoolCarePathwayfortheDyingPatient Palliativecare Assistedsuicide References[edit] ^Hui,David;Nooruddin,Zohra;Didwaniya,Neha;Dev,Rony;DeLaCruz,Maxine;Kim,SunHyun;Kwon,JungHye;Hutchins,Ronald;Liem,Christiana(1January2014)."ConceptsandDefinitionsfor"ActivelyDying,""EndofLife,""TerminallyIll,""TerminalCare,"and"TransitionofCare":ASystematicReview".JournalofPainandSymptomManagement.47(1):77–89.doi:10.1016/j.jpainsymman.2013.02.021.PMC 3870193.PMID 23796586. 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Furtherreading[edit] "LettingGo"byAtulGawande(link) "LastDaysofLife"forcancerpatientsprovidedbytheNationalCancerInstitute(link) "Livingwithaterminalillness"byMarieCurie(link) vteDeathInmedicineCelldeath Necrosis Avascularnecrosis Coagulativenecrosis Liquefactivenecrosis Gangrenousnecrosis Caseousnecrosis Fatnecrosis Fibrinoidnecrosis Temporallobenecrosis Programmedcelldeath AICD Anoikis Apoptosis Autophagy Intrinsicapoptosis Necroptosis Paraptosis Parthanatos Phenoptosis Pseudoapoptosis Pyroptosis Autolysis Autoschizis Eschar Immunogeniccelldeath Ischemiccelldeath Pyknosis Karyorrhexis Karyolysis Mitoticcatastrophe Suicidegene Abortion Accidentaldeath Autopsy Braindeath Brainstemdeath Clinicaldeath DOA Deathbynaturalcauses Deathrattle Dysthanasia End-of-lifecare Euthanasia Lazarussign Lazarussyndrome Medicaldeclarationofdeath Organdonation Terminalillness Unnaturaldeath Lists Causesofdeathbyrate Notabledeathsbyyear Expressionsrelatedtodeath Naturaldisasters Peoplebycauseofdeath Prematureobituaries Preventablecausesofdeath Unusualdeaths Listofwayspeopledishonorthedead Listofwayspeoplehonorthedead Mortality Birthdayeffect Childmortality Gompertz–Makehamlawofmortality Infantmortality Karoshi Maternaldeath Maternalmortalityinfiction Mementomori Micromort Mortalitydisplacement Mortalityrate RAMR Mortalitysalience Perinatalmortality AfterdeathBodyStages Pallormortis Algormortis Rigormortis Livormortis Putrefaction Decomposition Skeletonization Fossilization Preservation Cryopreservation Cryonics Neuropreservation Embalming Maceration Mummification Plastination Prosection Taxidermy Disposal Burial Naturalburial Cremation Dismemberment Excarnation Promession Resomation Beatingheartcadaver Bodydonation Cadavericspasm Coffinbirth Deatherection Dissection Gibbeting Postmortemcaloricity Post-morteminterval Otheraspects Afterlife Cemetery Consciousness Customs Crematorium Desecrationofgraves Examination Funeral Grief Intermediatestate Internet Mourning Onlinemourning Obituary Reincarnation Saṃsāra Resurrection Vigil Paranormal Ghosts Near-deathexperience Near-deathstudies Necromancy Out-of-bodyexperience Reincarnationresearch Séance Legal Abortionlaw Administration Capitalpunishment Causeofdeath Civildeath Coroner Death-qualifiedjury Deathcertificate Declareddeathinabsentia Deathrow Dyingdeclaration Inquest Legaldeath Murder Necropolitics Prohibitionofdying Righttodie Suspiciousdeath Trustlaw Will Fields Forensicpathology Funeraldirector Mortuaryscience Necrobiology Post-mortemchemistry Post-mortemphotography Taphonomy Biostratinomy Thanatology Other Apparentdeath Chineseburialmoney Coinsforthedead Darktourism DarwinAwards Deathandculture Deathanniversary Deathanxiety Deathdeity Personificationofdeath Dying-and-risinggod Psychopomp Deathcamp Deathdrive Deatheducation Deathfromlaughter Deathhoax Deathknell Deathmarch Deathmessenger Deathnotification Deathpanel Deathpoem Deathpose Death-positivemovement Deathsquad Deaththreat Deathtrajectory Dignifieddeath Extinction Fandeath FestivaloftheDead Fascinationwithdeath Hierarchyofdeath Homicide Immortality Lastrites Martyr Megadeth MuseumofDeath Necronym Necrophilia Necrophobia TheOrderoftheGoodDeath Predation Sacrifice human Suicide Assistedsuicide Thanatosensitivity Category Outline Authoritycontrol:Nationallibraries France(data) Israel UnitedStates Retrievedfrom"https://en.wikipedia.org/w/index.php?title=Terminal_illness&oldid=1090803851" Categories:MedicalterminologyPalliativecareMedicalaspectsofdeathHiddencategories:WebarchivetemplatewaybacklinksArticleswithshortdescriptionShortdescriptionisdifferentfromWikidataUsedmydatesfromSeptember2020ArticleswithBNFidentifiersArticleswithJ9UidentifiersArticleswithLCCNidentifiers Navigationmenu Personaltools NotloggedinTalkContributionsCreateaccountLogin Namespaces ArticleTalk English Views ReadEditViewhistory More Search Navigation MainpageContentsCurrenteventsRandomarticleAboutWikipediaContactusDonate Contribute HelpLearntoeditCommunityportalRecentchangesUploadfile Tools WhatlinkshereRelatedchangesUploadfileSpecialpagesPermanentlinkPageinformationCitethispageWikidataitem Print/export DownloadasPDFPrintableversion Languages العربيةবাংলাBân-lâm-gúCatalàDeutschEspañolEuskaraفارسی한국어HrvatskiItalianoעבריתNederlands日本語NorskbokmålPolskiPortuguêsSimpleEnglishسنڌيSrpskohrvatski/српскохрватскиSuomi中文 Editlinks