Palliative care
2. DEFINITIONS & TERMINOLOGIES
2.1. DEFINITIONS
1. Palliative Care:
Palliative care is "an approach that improves the QoL of patients (adults and
children) and their families who are facing problems associated with life-threatening
illness. It prevents and relieves suffering through early identification, correct assessment,
and treatment of pain and other problems, whether physical, psychosocial, or spiritual".
- WHO (2020)
2. Health:
Health is defined as "a state of complete physical, mental, and social well-being
and not merely the absence of disease or infirmity".
-WHO, (1948)
2. End-of-Life Care:
End-of-life care "helps all those with advanced, progressive, incurable illness to live
as well as possible, ensuring symptom control, comfort, dignity, and quality of life rather
than treatments aimed at cure or prolongation of life".
-National Institute for Health and Care Excellence (2021)
3. Palliative Sedation:
Palliative sedation is "the monitored use of sedative medications to relieve
intolerable suffering from refractory symptoms by a reduction in patient consciousness".
- Cherny NI et al., (2009)
4. Life-Limiting Illnesses:
Life-limiting illnesses are "conditions where death is expected as a direct
consequence of the disease, including cancer, organ failure, and progressive neurological
disorders".
-National Hospice and Palliative Care Organization, (2020)
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5. Hospice and Hospice Care:
Hospice care is "a philosophy of care that provides holistic support to patients with
advanced, progressive illness and their families, focusing on pain and symptom
management, psychological, social, and spiritual support".
-Connor SR, (2018)
6. Holistic Approach to Care:
Holistic care refers to "treatment that addresses the psychological, physical, social,
and spiritual needs of the patient to improve overall well-being".
-Ferrell BR, Coyle N, (2010)
7. Supportive Care:
It refers to "interventions aimed at helping patients maximize the benefits of
treatment and cope with the effects of their illness, including symptom control, nutritional
advice, and psychological support".
-European Society for Medical Oncology, (2020)
8. Quality of Life (QoL):
QoL is defined as "an individual’s perception of their position in life in the context
of the culture and value systems in which they live and in relation to their goals,
expectations, standards, and concerns".
-WHO, (1997)
9. Terminal Care:
Terminal care refers to "the management of patients in the final weeks or days of
life when curative treatment is no longer an option".
-National Cancer Institute, (2021)
10. Caregivers:
Caregivers are "family members, friends, or healthcare workers who provide
assistance to a patient with chronic or terminal illness".
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-National Alliance for Caregiving, (2020)
11. Multidisciplinary Care:
Multidisciplinary care is "an approach where professionals from different
disciplines collaborate to provide holistic care tailored to the patient’s needs".
-Temel JS et al., (2010)
2.2. TERMINOLOGIES
1. Dying with Dignity:
Dying with dignity means "ensuring that terminally ill patients receive
compassionate and ethical care that prioritizes comfort, quality of life, and respect for
their wishes".
-Gawande A, (2014)
2. Bereavement support:
Bereavement support refers to the emotional, psychosocial, and spiritual assistance
provided to individuals and families before and after the death of a loved one, aiming to
help them cope with grief, loss, and adjustment.
3. Death:
It is the irreversible cessation of all functions of the entire brain, including the
brainstem, or the irreversible cessation of circulatory and respiratory functions.
4. Continuum of care:
Continuum of care refers to an integrated system that guides and tracks patients
over time through a comprehensive array of health services spanning all levels of care
intensity.
5. Suffering:
It is the distress associated with events that threaten the well-being or wholeness of
the person.
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6. Spiritual pain:
Spiritual pain refers to disruption in the principle which pervades a person's entire
being and which integrates and transcends one's biological and psychosocial nature.
7. Psychosocial pain:
It refers to the distress experienced due to psychological and social factors,
encompassing emotions such as anxiety, depression, loneliness, guilt, and feelings of
diminished self-worth. These factors can significantly influence the perception and
intensity of physical pain
8. Terminal Illness:
An irreversible or incurable disease condition from which death is expected in the
foreseeable future.
9. Actively Dying:
The hours or days preceding imminent death during which time the patient’s
physiological functions wane.
10. Life Sustaining Treatment:
Life sustaining treatment comprises of any medical treatment that artificially
supports or replaces, a bodily function essential to the life of the person.
11. Potentially Inappropriate Treatment:
It connotes interventions aimed at cure that carry far greater possibilities of harm
than reasonable possibilities of benefit.
12. Cardiopulmonary Resuscitation (CPR):
It is an emergency medical procedure that combines chest compression often with
artificial ventilation.
13. Do Not Attempt Resuscitation (DNR):
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A decision not to initiate or perform CPR on the background of terminal illness in
accordance with prior expressed wishes of the patient or surrogate.
14. Withholding of Life Sustaining Treatment:
A decision made not to initiate or escalate a life-sustaining treatment in terminal
illness in accordance with expressed wishes of the patient or surrogate.
15. Withdrawal of Life Sustaining Treatment:
A decision made to cease or remove a lifesustaining intervention in terminal illness
in accordance with expressed wishes of the patient or surrogate.
16. Euthanasia:
Euthanasia is the intentional act of killing a terminally ill patient on voluntary
request, by the direct intervention of a doctor for the purpose of the good of the patient.
17. Physician Assisted Suicide:
An intentional act by the physician, on voluntary request of a dying patient with
terminal illness, providing the means or methods with which to help a person to end
his/her life.
18. Double Effect:
A principle that distinguishes the effects that are intended, from those that are
unintended but may be adverse though foreseeable.
19. Best Interests:
A concept that requires physicians to ensure potential benefits to outweigh harms
before undertaking medical interventions.
20. Healthcare Decision Making Capacity:
The capacity of a patient to make an independent, informed decision.
21. Shared Decision Making:
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A dynamic process with responsibility for decisions about the medical care of a
patient being shared between the health care team and the patient or surrogates.
22. Advance Directives:
A statement made by a person with decision-making capacity 8 stating his/her
wishes regarding how to be treated or not treated at a stage when s/he loses such capacity.
23. Autonomy:
It is the right of an individual to make a free and informed decision.
24. Beneficence:
A principle that makes it obligatory on the part of physicians to act in the best
interests of patients.
25. Non-maleficence:
A principle that directs physicians to first of all not do harm.
26. Justice:
In the context of medical care requires that all people be treated without prejudice
and that healthcare resources be used equitably.
