END OF LIFE & PALLIATIVE CAREDr. Wahyu Djatmiko, SpPD

Laboratorium / SMF Ilmu Penyakit DalamFKIK UNSOED - RSMS PURWOKERTO

Surat AliImran : 185 Tiap-tiap yang bernyawa akan mati Surat An nisaa :78 Dimanapun kamu berada,maka kematian itu akan mendatangimu,sekalipun kamu di dalam benteng yang kukuh.. Surat Al-jumuah : 8 Katankanlah,bahwasanya kematian yang kamu lari daripadanya,maka sesungguhnya ia akan menemui kamu KAPAN MANUSIA AKAN MATI ?

The Change of Death Conceptthe patient does not breaththe heart does not beatthe brain does not workdue to ventilators, pacemakersbrain brain-death brainstem-death

a. Mortality immortalityb. Monistic versus dualistic theory

Men thinks of the future with hope we always choose the good and nothing can be good without being good for all (Sartre, 1985)

Prof Djoko, 2002

TERAPIDIAGNOSISGOAL ?MEDIS TEKNIS

A PriambodoSIMALAKAMA.Tidak sekedar medis teknis

SERINGKALI DIAGNOSIS DOKTERLEBIH BERAT KETIMBANGVONIS HAKIMDIAGNOSIS BERITA BURUK ???

KEMATIAN Akhir perjalanan kehidupan individu Kebanyakan ingin menolak tapi tak kuasa Individu merasa konkrit dan absolut Ancaman menjadi TIADA KECEMASAN thd hilangnya eksistensi

KEMATIAN Tantangan emosional bg pasien, keluarga, teman dokter DOKTER : dulu harus menyembuhkan, kematian adalah kegagalan sekarang berbeda Perlu bantuan, dukungan, penghiburan Tindakan paliatif

TAHAPAN KEMATIAN(Kubler Ross) Menyangkal Kemarahan Tawar menawar Depresi PenerimaanTidak selalu berurutan, dpt bersamaan, kadang kembali ke tahap sebelumnya

KETAKUTAN(Ward, 1993) Takut menjadi diri sendiri Takut menjadi beban Takut mengalami nyeri Takut thd apa yg terjadi sesudah mati

PERSPEKTIF PASIEN Mendapatkan pengelolaan gejala yg adekuat Jangan sampai proses kematian berkepanjangan Perasaan yg terjaga dg baik Mengurangi beban keluarga Hubungan yang lebih erat dengan suami/istri atau keluarga

PROBLEM MENJELANG KEMATIAN Nyeri Sesak napas Gastrointestinal : Mual, muntah, konstipasi, inkontinensia alvi Inkontinensia uri Perubahan status mental : cemas, delirium, halusinasi, konfusi Kulit dan dekubitus Suasana duka (keluarga) Tempat mati (di RS, rumah, hospice?)

MEDIS TEKNIS( +Empati )HARAPAN / TAKUTKOMUNIKASITARGET HARUS REALISTIS

PASIENKELUARGAD O K T E R( Tim Medis )KapabelInkapabelA. Keputusan : Bermanfaat Menjadi beban keraguanB. Konflik keluarga Pengetahuan Harapan semu ? Ketakutan

APA YANG DOKTER TELAH LAKUKAN ?APA PROGRAM DOKTER SELANJUTNYA?TERSERAH DOKTER, YANG PENTING SEMBUHKAMI TELAH PASRAHdst

Discuss with the patient : (in the deathing period)How do want your ideal deathWhere are going to die?Do you want to die alone or ?Do want to settle something ?Any medical advisor choice Prof Djoko, 2002

Dr Almagors advice for health professionals: Listen carefullyHelping him to cure their diseasesRespond to their distress and anxietiesMaking effort to help themDemonstrate your sensitivity to physical indignitiesMake him feel like human beingIncrease their self-respectsProf Djoko, 2002

Palliative CareReducing the severitydenoting the alleviation of symptoms without curing the underlying diseasePalliative care is specialized medical care for people with serious illnesses.

Dying process and other symptoms (pain, dyspnoea etc) can be relieved by technique of palliative medicineIt focuses on providing patients with relief from the symptoms, pain, and stress of a serious illnesswhatever the diagnosis.The goal is to improve quality of life for both the patient and the family.

Palliative care treats people suffering from serious and chronic illnesses such as : CancerCardiac diseaseCOPD Kidney failureAlzheimersParkinsonsand many more

Palliative care focuses on symptomsPain Shortness of breathFatigueConstipationNauseaLoss of appetiteDifficulty sleeping and depressionIt also helps you gain the strength to carry on with daily lifeIt improves your ability to tolerate medical treatments. It helps you have more control over your care by improving your understanding of your choices for treatment.

The network of palliative care

Palliative care is for a person of any age who has a serious illness. For example, you may want palliative care while you are getting treatment for heart failure. Palliative care could help you manage symptoms or side effects of treatment so that you will feel better.

Hospice care provides medical services, emotional support, and spiritual resources for people who are in the last stages of a serious illness, such as cancer or heart failure.

Palliative Care vs Hospice Care

PERAWATAN PALIATIF(WHO) Meningkatkan kualitas hidup, anggap kematian sbg proses normal Tidak mempercepat atau menunda kematian Hilangkan nyeri atau keluhan lain yg mengganggu Menjaga keseimbangan psikologis dan spiritual Berusaha agar penderita tetap aktif sampai akhir hayat Berusaha mengatasi suasana duka cita keluarga

ICU/ICCU indikasi ? Bgmn dg ventilator / pace maker / inotropik? reversibel atau tidak ? Batasan kultural / Agama ? Misal : Transfusi darah ? Nutrisi (Energi dan hidrasi) : Enteral / Parenteral Terapi simtomatik / paliatif DNR EuthansiaDISKUSI

The dying patients should be treated as a total human being

DYING WITH DIGNITY