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Doctor-Patient Relationship

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Doctor-Patient Relationship

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Doctor-Patient Relationship

  1. 1. DOCTOR PATIENTDOCTOR PATIENT RELATIONSHIPRELATIONSHIP
  2. 2. INTRODUCTIONINTRODUCTION ““The duty of the doctor is toThe duty of the doctor is to provide solace. It is for the GODprovide solace. It is for the GOD ALMIGHTY to cure the illness”.ALMIGHTY to cure the illness”. ((Hadis-e-Qudsi).Hadis-e-Qudsi).
  3. 3. ““Each person who is admitted to a hospitalEach person who is admitted to a hospital brings with him not only a physical illnessbrings with him not only a physical illness but also a definite mental set that willbut also a definite mental set that will influence both the manner in which heinfluence both the manner in which he assumes his role as a patient and theassumes his role as a patient and the course of his hospitalization”.course of his hospitalization”. Robinson,1984Robinson,1984
  4. 4. OBJECTIVESOBJECTIVES  Improves careImproves care  Improves your clinical skillsImproves your clinical skills  Fosters participation in treatmentFosters participation in treatment  Facilitates holistic approach to careFacilitates holistic approach to care
  5. 5. OUTLINE OF LECTUREOUTLINE OF LECTURE 1.1. Clarification of concepts in doctor-patientClarification of concepts in doctor-patient relationshiprelationship 2.2. Biopsychosocial model of therapyBiopsychosocial model of therapy 3.3. Interview methodology and environmentInterview methodology and environment 4.4. Communication/interaction and counselingCommunication/interaction and counseling 5.5. Medical ethicsMedical ethics 6.6. Islamic oath for practice of medicineIslamic oath for practice of medicine 7.7. Hippocratic OathHippocratic Oath 8.8. The dying person’s bill of rightsThe dying person’s bill of rights
  6. 6. RAPPORTRAPPORT  Spontaneous and conscious feelingSpontaneous and conscious feeling of harmonious responsiveness thatof harmonious responsiveness that facilitates a useful therapeuticfacilitates a useful therapeutic relationship.relationship.  Basis of understanding and trustBasis of understanding and trust between the therapist and the patient.between the therapist and the patient.  Gives a feeling of acceptance and toGives a feeling of acceptance and to share the problem with the doctor.share the problem with the doctor.
  7. 7. SPIRITUALITYSPIRITUALITY  Gaining increased importance in everyGaining increased importance in every society and culture both in health andsociety and culture both in health and sickness.sickness.  Patient’s mental and physical health isPatient’s mental and physical health is influenced significantly by spiritual andinfluenced significantly by spiritual and religious beliefs and commitments.religious beliefs and commitments.  Therapists act asTherapists act as religiousreligious counselors.counselors.
  8. 8. ILLNESS BEHAVIORILLNESS BEHAVIOR ““patient’s reaction to thepatient’s reaction to the experience of being sick orexperience of being sick or disabled.”disabled.”  Synonymous toSynonymous to sick rolesick role  Habitual modes of thinking andHabitual modes of thinking and feelings further shape the sick role.feelings further shape the sick role. Contd.Contd.
  9. 9.  Largely depends on patient’s pastLargely depends on patient’s past experience, personality, attitude ofexperience, personality, attitude of the family during sickness and thethe family during sickness and the extent of relief from personal or socialextent of relief from personal or social obligations due to illness.obligations due to illness.
  10. 10. TRANSFERENCE ANDTRANSFERENCE AND COUNTERCOUNTER TRANSFERENCETRANSFERENCE  Origin inOrigin in PsychoanalysisPsychoanalysis..  The views and attitudes of patientsThe views and attitudes of patients and doctors about each other whichand doctors about each other which may be reality orientated or based onmay be reality orientated or based on the experiences and their relationshipthe experiences and their relationship with parents during childhood.with parents during childhood. Contd.Contd.
  11. 11.  Such views affect positively orSuch views affect positively or negatively doctor patient interaction.negatively doctor patient interaction.
  12. 12. TRANSFERENCETRANSFERENCE  A process of patient’sA process of patient’s unconsciousunconscious attributionattribution of feelings to doctor in theof feelings to doctor in the background of his / her emotionalbackground of his / her emotional relationship with parents.relationship with parents.  The patient’s behavior may beThe patient’s behavior may be demanding, harsh, caring or evendemanding, harsh, caring or even seductive.seductive. Contd.Contd.
  13. 13.  Infact the transfer of past feelings toInfact the transfer of past feelings to the doctors.the doctors.  Encouraging transference reaction isEncouraging transference reaction is at times an integral part ofat times an integral part of psychotherapy.psychotherapy.
  14. 14. COUNTERCOUNTER TRANSFERENCETRANSFERENCE  The process by which a doctorThe process by which a doctor unconsciously attributesunconsciously attributes his feelinghis feeling to the patient in the background of histo the patient in the background of his past relationshippast relationship  It may take the form of negativeIt may take the form of negative feelings or positive idealizing andfeelings or positive idealizing and even eroticizing reactionseven eroticizing reactions..
  15. 15.  Doctors need to be insightful to suchDoctors need to be insightful to such reactions and should rise above suchreactions and should rise above such emotions for the sake of better doctoremotions for the sake of better doctor patient interaction.patient interaction.
  16. 16. THERAPEUTIC MODELTHERAPEUTIC MODEL  Biopsychosocial ModelBiopsychosocial Model The concept of Biopsychosocial ModelThe concept of Biopsychosocial Model of therapy is a relatively new conceptof therapy is a relatively new concept since the patient is exposed to asince the patient is exposed to a complex physical and psychologicalcomplex physical and psychological make up during sickness. Therefore,make up during sickness. Therefore, the psychosocial environment is likelythe psychosocial environment is likely to influence the behavior, the outcometo influence the behavior, the outcome and the ultimate prognosis of theand the ultimate prognosis of the underlying physical disability.underlying physical disability.
  17. 17.  The psychological constitutionThe psychological constitution provides an elaborate personalityprovides an elaborate personality structure as well as the attitudes andstructure as well as the attitudes and the reaction pattern of an individualthe reaction pattern of an individual and his illness behavior.and his illness behavior.
  18. 18.  This behavior is also shaped byThis behavior is also shaped by culture, the society and social supportculture, the society and social support during times of crises.during times of crises.
  19. 19.  By understanding of this complex eraBy understanding of this complex era of the interaction between differentof the interaction between different biochemical, psychological and socialbiochemical, psychological and social factors the therapist can plan anfactors the therapist can plan an effective treatment strategy as well aseffective treatment strategy as well as can manipulate those variety ofcan manipulate those variety of factors in the management of thefactors in the management of the sickness.sickness.
  20. 20.  It should be emphasized that theIt should be emphasized that the events following sickness of theevents following sickness of the person/relatives whether pleasant orperson/relatives whether pleasant or unpleasant also determine the reactionunpleasant also determine the reaction pattern of the people.pattern of the people.
  21. 21.  The knowledge of this aspect ofThe knowledge of this aspect of clinical medicine is another foundationclinical medicine is another foundation in doctor-patient relationship apartin doctor-patient relationship apart from communication and interactionfrom communication and interaction skills.skills.
  22. 22. MEDICAL INTERVIEWSMEDICAL INTERVIEWS  Aspects of an effectiveAspects of an effective interviewing include:interviewing include:  Patient’s factorsPatient’s factors like personality,like personality, character style and emotionalcharacter style and emotional status.status.  Clinical settingsClinical settings like interviewinglike interviewing the patient in emergency room,the patient in emergency room, hospital wards, out patienthospital wards, out patient department or a psychiatric ward.department or a psychiatric ward.
  23. 23.  Frequent interruptions throughFrequent interruptions through::  telephone callstelephone calls  presence of an interpreterpresence of an interpreter  note takingnote taking  nature of patient’s problem/illnessnature of patient’s problem/illness  interviewer’s methodologyinterviewer’s methodology  his experience andhis experience and  his theoretical orientation also havehis theoretical orientation also have impact an interviewing.impact an interviewing.
  24. 24. THREE MAIN FUNCTIONSTHREE MAIN FUNCTIONS OF A MEDICALOF A MEDICAL INTERVIEWINTERVIEW 1.1. Determining theDetermining the nature of the problemnature of the problem 2.2. Developing andDeveloping and maintaining amaintaining a therapeutic relationship.therapeutic relationship. 3.3. CommunicatingCommunicating information andinformation and implementing aimplementing a treatment plan.treatment plan.
  25. 25. COMMUNICATION/COMMUNICATION/ INTERACTIONINTERACTION a.a. Provides concise, accurate, andProvides concise, accurate, and timely overview of client’s statementstimely overview of client’s statements and help them to organize theirand help them to organize their thoughtsthoughts b.b. Helps a client to review what hasHelps a client to review what has been saidbeen said c.c. Stimulates a thorough exploration ofStimulates a thorough exploration of themes that are important to the clientthemes that are important to the client
  26. 26.  You can summarize:You can summarize: Non verbal communication,Non verbal communication, active listening and verbalactive listening and verbal expressions are some of the essentialexpressions are some of the essential components of an effectivecomponents of an effective communication.communication.
  27. 27. Q. Which of the following kinds ofQ. Which of the following kinds of communication is most effective incommunication is most effective in delivering information?delivering information? a)a) VerbalVerbal b)b) Tone of the voice and accentTone of the voice and accent c)c) Facial expressionsFacial expressions d)d) Eye contactEye contact
  28. 28. THERAPEUTICTHERAPEUTIC COMMUNICATION/COMMUNICATION/ INTERACTIONSINTERACTIONS  TherapeuticTherapeutic interaction facilitatesinteraction facilitates growth, development,growth, development, maturity, improvedmaturity, improved functioning andfunctioning and improved coping.improved coping.
  29. 29. Social InteractionsSocial Interactions It occurs daily as the staff greets theIt occurs daily as the staff greets the patient with comments/questions suchpatient with comments/questions such as;as; “ Good Morning”.“ Good Morning”. “ How are your Children?”.“ How are your Children?”. “ Has anybody visited you“ Has anybody visited you yesterday?”yesterday?”
  30. 30. Therapeutic InteractionsTherapeutic Interactions  During this the staff helps the patientDuring this the staff helps the patient to communicate feelings, fears,to communicate feelings, fears, anxieties, frustrations etc. withanxieties, frustrations etc. with comments such as;comments such as;  ““ You look upset. Would youYou look upset. Would you like to share your feelings withlike to share your feelings with me? I will sit with you till theme? I will sit with you till the pain medication takes effect”.pain medication takes effect”.
  31. 31. EFFECTIVEEFFECTIVE COUNSELORCOUNSELOR  Self awarenessSelf awareness  Awareness of cultural experiencesAwareness of cultural experiences  Empathy, genuineness and non-Empathy, genuineness and non- judgmental attitudejudgmental attitude  Ability to communicate and toAbility to communicate and to understand the expectations of theunderstand the expectations of the patientpatient
  32. 32.  Knowledge & intellectualKnowledge & intellectual competencecompetence  Immediacy of relationshipImmediacy of relationship  AttractivenessAttractiveness  HonestyHonesty  TrustworthinessTrustworthiness
  33. 33. NON-VERBALNON-VERBAL COMMUNICATIONCOMMUNICATION  Non-verbal communication or bodyNon-verbal communication or body language plays an important part inlanguage plays an important part in the messages we relay to otherthe messages we relay to other people.people.  It also refers to the way in which theIt also refers to the way in which the words are projected.words are projected.
  34. 34.  It can hinder or facilitate theIt can hinder or facilitate the communication depending uponcommunication depending upon the mode of delivery of the wordsthe mode of delivery of the words and expressions of theand expressions of the communicator.communicator.
  35. 35.  The important variables in non verbalThe important variables in non verbal communication are:communication are: a)a) PosturePosture b)b) Personal spacePersonal space c)c) Eye contactEye contact d)d) Head nodsHead nods e)e) Facial expressionsFacial expressions f)f) Body movements and hand gesturesBody movements and hand gestures g)g) Tone of voiceTone of voice
  36. 36. Breaking News Of ABreaking News Of A Serious And A TerminalSerious And A Terminal IllnessIllness 1.1. Plan in mind before startingPlan in mind before starting 2.2. Imparting adequate information toImparting adequate information to the patientthe patient a.a. Be honest and know about yourBe honest and know about your limitations and uncertainty oflimitations and uncertainty of diagnosisdiagnosis
  37. 37. b.b. Be warm and understandingBe warm and understanding c.c. Use basic counseling skillsUse basic counseling skills d.d. Be a source of support andBe a source of support and encouragement and know that grief,encouragement and know that grief, anger and despair are normalanger and despair are normal e.e. Encourage questionsEncourage questions f.f. Be prepared to spend more time withBe prepared to spend more time with the patient for exploring alternativethe patient for exploring alternative management strategiesmanagement strategies
  38. 38. 3.3. Environment:Environment: i.i. What to say and when to sayWhat to say and when to say ii.ii. Presence of other close associatesPresence of other close associates
  39. 39. How To SayHow To Say 1.1. Introduce yourself and the subject ofIntroduce yourself and the subject of discussionsdiscussions 2.2. Feel concerned, ensure eye contactFeel concerned, ensure eye contact and be humaneand be humane 3.3. Use simple language with warmthUse simple language with warmth 4.4. Indicate facts and ensure detailsIndicate facts and ensure details 5.5. Give sufficient time for questionsGive sufficient time for questions and inquiriesand inquiries
  40. 40. 6.6. Allow the patient to be with relativesAllow the patient to be with relatives for time in order to enable thefor time in order to enable the patient to generate inner strengthpatient to generate inner strength and supportand support 7.7. Give patient time to integrate andGive patient time to integrate and don’t try to stop the flow of emotionsdon’t try to stop the flow of emotions 8.8. Soften the bad news with good newsSoften the bad news with good news or at least hopeor at least hope
  41. 41.  Further Plan of ActionFurther Plan of Action  Speak honestly and in terms of the rangeSpeak honestly and in terms of the range of the possibilities especially when theof the possibilities especially when the diagnosis is malignancy (cancer)diagnosis is malignancy (cancer)  The dialogue and mutual confidenceThe dialogue and mutual confidence should continueshould continue  Continue instilling hopeContinue instilling hope  Try to mobilize coping mechanisms ofTry to mobilize coping mechanisms of the patient after sudden disclosure ofthe patient after sudden disclosure of painful informationpainful information
  42. 42.  Participate in decision making forParticipate in decision making for further treatmentfurther treatment  The mechanism of denial should beThe mechanism of denial should be owned initially because it is aowned initially because it is a protective mechanismprotective mechanism
  43. 43.  Encourage patient to make intelligentEncourage patient to make intelligent decisions about his/her own treatmentdecisions about his/her own treatment  See patients’ relatives individually toSee patients’ relatives individually to address their fears and foraddress their fears and for mobilization of supportmobilization of support
  44. 44. Models of InteractionModels of Interaction 1.1. Paternalistic modelPaternalistic model 2.2. Informative modelInformative model 3.3. Interpretive modelInterpretive model 4.4. Deliberative modelDeliberative model
  45. 45. MEDICAL ETHICSMEDICAL ETHICS Q. A 25-year-old man who is HIV-positiveQ. A 25-year-old man who is HIV-positive comes to a physician’s office for treatmentcomes to a physician’s office for treatment of a skin lesion. Because she is afraid ofof a skin lesion. Because she is afraid of infection, the physician refuses to treat him.infection, the physician refuses to treat him. This physician's refusal to treat the patientThis physician's refusal to treat the patient is best described as:is best described as: a.a. Unethical and illegalUnethical and illegal b.b. Ethical and legalEthical and legal c.c. Unethical but legalUnethical but legal d.d. Ethical but illegalEthical but illegal
  46. 46. MEDICAL ETHICSMEDICAL ETHICS  The ethical concerns of care areThe ethical concerns of care are an integral part of medicine &an integral part of medicine & doctor-patient relationship.doctor-patient relationship.  A modern branch of moralA modern branch of moral philosophy concerned with moralphilosophy concerned with moral problems in medical practice, policyproblems in medical practice, policy and research.and research.
  47. 47.  These also include legal issues suchThese also include legal issues such as informed consent and termination ofas informed consent and termination of care.care.  Psychiatric and behavior medicinePsychiatric and behavior medicine issues are another importantissues are another important consideration of medical ethics.consideration of medical ethics.  In due course issues likeIn due course issues like E-consultations, relationship withE-consultations, relationship with Media and pharmaceutical industry willMedia and pharmaceutical industry will have to be considered and addressed.have to be considered and addressed.
  48. 48. Medical Ethics also include moral, legal and religious issues related to: Tissue transplant Organ transplant, IVF (Test tube babies) Diagnostic procedures (Amniocentesis) Termination of pregnancy etc.
  49. 49. Q. A 16 years old male high school studentQ. A 16 years old male high school student has an appointment with the physicianhas an appointment with the physician because of recurrent pain abdomen forbecause of recurrent pain abdomen for the past one month. The primarythe past one month. The primary concern in the patient mind is:concern in the patient mind is: a.a. ConfidentialityConfidentiality b.b. Reassurance that the illness is notReassurance that the illness is not seriousserious c.c. Competence of the physicianCompetence of the physician d.d. How to explain illness to his mates byHow to explain illness to his mates by the patientthe patient
  50. 50. INFORMED CONSENTINFORMED CONSENT
  51. 51. CONFIDENTIALITYCONFIDENTIALITY  It may be necessary to reassureIt may be necessary to reassure a patient that confidentiality will bea patient that confidentiality will be maintained except when:maintained except when:  Information may be harmful toInformation may be harmful to the patient or others.the patient or others.  Patient does not intend to complyPatient does not intend to comply with the treatment planwith the treatment plan  Patient threatensPatient threatens self-harm.self-harm.
  52. 52. EUTHANASIAEUTHANASIA (Mercy Killing)(Mercy Killing)  It is defined as a physician’s deliberateIt is defined as a physician’s deliberate act to cause a patient death inact to cause a patient death in hopelessly ill or injured patients.hopelessly ill or injured patients.  Active EuthanasiaActive Euthanasia  Passive EuthanasiaPassive Euthanasia  Voluntary EuthanasiaVoluntary Euthanasia  Involuntary EuthanasiaInvoluntary Euthanasia
  53. 53. ISLAMIC OATHISLAMIC OATH ““IN THE NAME OF ALLAH,IN THE NAME OF ALLAH, MOST GRACIOUS, MOSTMOST GRACIOUS, MOST MERVCIFUL”MERVCIFUL” ““Praise to be Allah, thePraise to be Allah, the Sustainer of His Creation, theSustainer of His Creation, the All-knowing. Glory be to Him,All-knowing. Glory be to Him, the Eternal, the All-Pervading”the Eternal, the All-Pervading”
  54. 54.  ““O Allah, Thou art the onlyO Allah, Thou art the only Healer, I serve none but thee,Healer, I serve none but thee, and, as the instrument of Thyand, as the instrument of Thy Will, I commit myself to Thee”Will, I commit myself to Thee”
  55. 55. I Dr------------------------- render thisI Dr------------------------- render this Oath in Thy Holy Name and IOath in Thy Holy Name and I undertake:undertake: To be the instrument of Thy Will andTo be the instrument of Thy Will and Mercy, and, in all humbleness, toMercy, and, in all humbleness, to exercise justice, love andexercise justice, love and compassion for all Thy Creation;compassion for all Thy Creation;
  56. 56. To extend my hand of service to oneTo extend my hand of service to one and all, to the rich and to the poor, toand all, to the rich and to the poor, to friend and foe alike, regardless offriend and foe alike, regardless of race, religion or colour;race, religion or colour; To hold human life as precious andTo hold human life as precious and sacred, and to protect and honour itsacred, and to protect and honour it at all times and under allat all times and under all circumstances in accordance withcircumstances in accordance with Thy Law;Thy Law;
  57. 57. To do my utmost to alleviate pain andTo do my utmost to alleviate pain and misery, and to comfort and counselmisery, and to comfort and counsel human beings in sickness and inhuman beings in sickness and in anxiety; To respect the confidence andanxiety; To respect the confidence and guard the secrets of all my patients;guard the secrets of all my patients; To maintain the dignity of health care, andTo maintain the dignity of health care, and to honour the teachers, students, andto honour the teachers, students, and members of my profession;members of my profession;
  58. 58. To strive in the pursuit of knowledge inTo strive in the pursuit of knowledge in Thy name for the benefit of mankind,Thy name for the benefit of mankind, and to uphold human honour andand to uphold human honour and dignity;dignity; To acquire the courage to admit myTo acquire the courage to admit my mistakes, mend my ways and tomistakes, mend my ways and to forgive the wrongs of others;forgive the wrongs of others;
  59. 59. To be ever-conscious of my duty toTo be ever-conscious of my duty to Allah and His Messenger (S.A.W.),Allah and His Messenger (S.A.W.), and to follow the precepts of Islam inand to follow the precepts of Islam in private and in public.private and in public. ““Allah grant me the strength, patienceAllah grant me the strength, patience and dedication to adhere to thisand dedication to adhere to this Oath at all times”Oath at all times”
  60. 60. HIPPOCRATIC OATHHIPPOCRATIC OATH  II swear by Apollo theswear by Apollo the physician, and Aesculapius,physician, and Aesculapius, Hygeia and Panacea and all theHygeia and Panacea and all the gods and goddesses, that,gods and goddesses, that, according to my ability andaccording to my ability and judgment, I will keep this Oathjudgment, I will keep this Oath and this covenant.and this covenant.
  61. 61.  To reckon him who taught me this ArtTo reckon him who taught me this Art equally dear to me as my parents, toequally dear to me as my parents, to share my substance with him, andshare my substance with him, and relieve his necessities if required; torelieve his necessities if required; to look upon his offspring on the samelook upon his offspring on the same footing as my own brothers, and tofooting as my own brothers, and to teach them this Art, if they shall wish toteach them this Art, if they shall wish to learn it, without fee or stipulation; andlearn it, without fee or stipulation; and that by precept, lecture, and everythat by precept, lecture, and every other mode of instruction,……..other mode of instruction,…….. ContdContd
  62. 62.  I will impart a knowledge of the Art toI will impart a knowledge of the Art to my own sons, and those of mymy own sons, and those of my teachers, and to disciples who haveteachers, and to disciples who have signed the covenant and have takensigned the covenant and have taken an oath according to the law ofan oath according to the law of medicine, but no one else.medicine, but no one else.
  63. 63.  I will follow that system of regimenI will follow that system of regimen which, according to my ability andwhich, according to my ability and judgment, I consider for the benefit of myjudgment, I consider for the benefit of my patients, and abstain from whatever ispatients, and abstain from whatever is deleterious and mischievous.  I will givedeleterious and mischievous.  I will give no deadly medicine to anyone if asked,no deadly medicine to anyone if asked, nor suggest any such counsel; and in likenor suggest any such counsel; and in like manner I will not give to a woman anmanner I will not give to a woman an abortive remedy. With purity and withabortive remedy. With purity and with holiness I will pass my life and practiceholiness I will pass my life and practice my Art.my Art.
  64. 64.  I will not cut persons labouring underI will not cut persons labouring under the stone, but will leave this to bethe stone, but will leave this to be done by such men as aredone by such men as are practitioners of this work.  Intopractitioners of this work.  Into whatever houses I enter, I will go intowhatever houses I enter, I will go into them for the benefit of the sick, andthem for the benefit of the sick, and will abstain from every voluntary actwill abstain from every voluntary act of mischief and corruption; and,of mischief and corruption; and, further, from the seduction of femalesfurther, from the seduction of females or males, of freemen and slaves.or males, of freemen and slaves.
  65. 65.  Whatever, in connection with myWhatever, in connection with my professional practice, or not inprofessional practice, or not in connection with it, I see or hear, in theconnection with it, I see or hear, in the life of men, which ought not to belife of men, which ought not to be spoken of abroad, I will not divulge, asspoken of abroad, I will not divulge, as reckoning that all such should be keptreckoning that all such should be kept secret. secret. 
  66. 66. While I continue to keep this OathWhile I continue to keep this Oath unviolated, may it be granted to me tounviolated, may it be granted to me to enjoy life and practice of the Art,enjoy life and practice of the Art, respected by all men, in all times. Butrespected by all men, in all times. But should I trespass and violate thisshould I trespass and violate this Oath, may the reverse be my lot.Oath, may the reverse be my lot.
  67. 67. Needs of the Dying PatientNeeds of the Dying Patient  Holist (1984) statesHolist (1984) states “families and patients“families and patients may die too manymay die too many things before thethings before the disease finally takesdisease finally takes life”.life”.
  68. 68.  Optimism, spontaneity, holidays, long –Optimism, spontaneity, holidays, long – range planning, dreams, retirement, andrange planning, dreams, retirement, and grandparenthood are but a few of thegrandparenthood are but a few of the many things that die as a person and hermany things that die as a person and her or his family live with a terminal illnessor his family live with a terminal illness..
  69. 69. The Dying Person’s Bill ofThe Dying Person’s Bill of RightsRights  I have the right to be treated as a livingI have the right to be treated as a living human being until die.human being until die. I have the right to maintain a sense ofI have the right to maintain a sense of hopefulness however changing its focushopefulness however changing its focus may be.may be. I have the right to be cared for by thoseI have the right to be cared for by those who can maintain a sense ofwho can maintain a sense of hopefulness, however changing thishopefulness, however changing this might be.might be.
  70. 70.  I have the right to express myI have the right to express my feelings and emotions about myfeelings and emotions about my approaching death in my own say.approaching death in my own say. I have the right to expect continuingI have the right to expect continuing medical and nursing attention evenmedical and nursing attention even though “cure” goals must be changedthough “cure” goals must be changed to “comfort goals”to “comfort goals” I have the right not to die alone.I have the right not to die alone.
  71. 71. I have the right to have my questionsI have the right to have my questions answered honestly.answered honestly. I have the right not to be deceived.I have the right not to be deceived. I have the right to have help from and forI have the right to have help from and for my family in accepting my death.my family in accepting my death. I have the right to die in peace and withI have the right to die in peace and with dignity.dignity.
  72. 72.  I have the right to retain myI have the right to retain my individuality and not be judged for myindividuality and not be judged for my decision, which may be contrary todecision, which may be contrary to beliefs or others.beliefs or others. I have the right to discuss andI have the right to discuss and enlarge my religious and / or spiritualenlarge my religious and / or spiritual experiences, whatever these mayexperiences, whatever these may mean to others.mean to others.
  73. 73.  I have the right to expect that theI have the right to expect that the sanctity of the human body will besanctity of the human body will be respected after death.respected after death. I have the right to be cared for byI have the right to be cared for by caring, sensitive, knowledgeablecaring, sensitive, knowledgeable people who will attempt to understandpeople who will attempt to understand my needs and will be ale to gain somemy needs and will be ale to gain some satisfaction in helping me to face mysatisfaction in helping me to face my death.death.
  74. 74. Image Of Doctors In TheImage Of Doctors In The CommunityCommunity
  75. 75. CONCLUSIONCONCLUSION

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