“We cannot banish dangers, but we can banish fears. We must not demean life by standing in awe of death.” – David Sarnoff

As student physiotherapists we experience life and death on a regular basis. I have currently been on clinical block at a large government hospital where I have been exposed to a great variety of patients and outlooks on death. When working in the orthopaedic wards I worked with and treated many people who had been in motor vehicle accidents of pedestrian vehicle accidents, and most of these people looked forward to returning to their highest functional abilities. The generalised view I received from these patients was that they had escaped death and now looked forward to living life to its fullest potential.

While working in the medical wards however I encountered a different perspective towards life and death. Unlike the orthopaedic patients I treated, I was exposed to a higher percentage of patient deaths in the medical wards. These patients often had chronic illnesses such as cancer or chronic respiratory related conditions. I found it strange how my reactions towards these patient deaths varied, as well as the reactions of my clinicians toward the deaths. Its hard to admit that when you go insearch of a patient, whom you cant find and are told that the patient has, “Joined our father in the heavens,” or, “Sadly passed away,” that you no longer feel traumatised by this news, and your response is said in such a way in order to sympathize with the attending nurse from whom you recieved the information, before you move on to find your next patient.

Dealing with death:

When dealing with patient death there are a variety of reactions which can occur depending on the therapist, the patient, and the interaction between the two. I remember the first time I walked in to a room to treat a patient who was in the process of dying- she was lying in bed gasping for air. I rushed out the room to find a nurse who could help, only to be informed that, “She is dying.” This was a patient who I had seen regularly for approximately a week and I found her to be optimistic, always wanting to partake in physiotherapy despite her condition. What made the experience more traumatic was that when entering the room I had been carrying a walking frame which I had left at the end of her bed, and needed to retrieve, requiring me to reenter the room, face the patient and somehow pick the frame up and walk away.

An article by Janet Wright (2015): Dying to Help: Counselling and Support for Physios Following the death of a Patient shows how support systems can help a therapist deal with patient death. This is the second article, preceded by: You Only Die Once: End of Life Care (Wright, 2015), which discussed the impacts of physiotherapy near the end of a patient’s life. Janet Wright (2015) reports how regular counselloring for therapists at a hospital who treat cystic fibrosis patients benefit, while also indicating that this is not always possible at all heath care facilities. Other methods are also mentioned, such as a buddy system which was found ineffective with a low compliency level from the staff.

A research study by Powell and Toms (2014), looked at the impact of a patient death on a physiotherapist and the coping strategies used. This study concluded that students are more likely to be effected on a greater scale than health professionals who have developed coping strategies. The article goes into detail of the initial reaction to patient death which the therapist has, and the impact of the reactions to those surrounding them. It is also mentioned in this article that the severity of the reaction towards the patient death is the amount of interaction or the amount of a relationship you have built with the patient in question.

Terminal Illness:

Kim Nguyen (2012), performed a study which researched the terminally ill patient’s thoughts and concerns at end of life. During this study it highlights that how, “Unlike in the past when they had few options for managing illness, they now had a choice between treatment and no treatment,”(Nguyen, 2012) and, “Confronting this choice and this life brought to light a goal different from merely staying alive longer: the goal to live in a way that one finds worthwhile,” (Nguyen, 2012). I believe that these two quotes give a great amount of meaning to the care patients who are terminally ill recieve. A patient who is terminally ill might want to partake in physiotherapy because it will improve their remaining quality of life until their death, but this can also recieved in an opposing manner if the patient believes that partaking in physiotherapy near the end of their life is worthwhile enough to them. A patient could find physiotherapy help them maintain as much independence as possible until their death, or they could find it not worth the effort and would prefer to relax and not partake in physiotherapy treatment at the end of their life.

Suicide and assisted suicide:

ProCon.Org (2013) published an interesting list of the top 10 pro/ con arguements for assisted suicide which quoted various sources on their opinions on the matter. Prior top reading this my thoughts on assisted suicide were varied and inconclusive. I acknowledged the reasons as to why a person might benefit from assisted suicide by being relieved from chronic pain, I also acknowledged the problems this might encounter such as reliabilty of the person’s decision and if legal problems this might cause, as well as the fear of someone deciding upon assisted suicide before a new treatment was made available. Under the context of legalisation Michael Irwin (2013) is quoted saying, “The right to die should be a matter of personal choice,” however this very strong arguement was opposed by Richard Doerflinger (2017) who showed me that the legalisation of assisted suicide could change society’s perspective on this topic which would lead to more people choosing this option who would not have wanted to prior to the legalisation. The other major brought up by this article was the obligation that the health professional makes to never harm the patient and how assisted suicide is classified in this perspective. I previously believed myself able to argue both sides, while being personally more inclined against assisted suicide with the ability to argue differently on a case to case basis, however I now suprisingly find myself more opposed to the idea of assisted suicide despite the great aguements in favour of assisted suicide.

Abortion:

The debate on whether abortion is right or wrong is diverse and in my opinion a more sensitive topic to those in society than the debate of assisted suicide. “Abortion is killing innocent babies. Abortion is like the Holocaust,” (Borgmann, 2009). When discussing abortion under, “Meaningful life and death,” It is important that we aknowledge that there are two lives impacted by abortion: The child and the mother. Will the birth of the child make the mother’s life more or less meaningful? Will the birth of the child lead to a meaningful life of the child? What is classified as a meaningful life? The choice to either take the action of abortion or not is influenced by a variety of factors other than religous and cultural belief. When deciding on whether to partake in abortion or not, the mother often is influenced by how she became pregant, her health status and the status of the child. I believe that when approaching the subject of abortion everyone is entitled to their own opinion of how they would take action themselves. I believe that it is important that we do not judge people on their actions regarding this topic. If a mother decides to choose abortion it is her choice and it is our responsibility to acknowledge that and not treat her unfairly due to this choice. A mother who chooses to not choose abortion should be treated the same despite her circumstances. Choosing to abort or not to do so is a life changing decision which deserves support no matter the outcome.

References:

1. Powell, S., & Toms, J. (2014). Passing Away: An Exploratory Study into Physiotherapy Students’ Experiences of Patient Death whilst on Clinical Placement. International Journal Of Practice-Based Learning In Health And Social Care, 2(1), 108-121. http://dx.doi.org/10.11120/pblh.2014.00026
2. Ovsyannykov, I. (2018). 30 Profound Quotes about Death to Live a Meaningful Life | Inspirationfeed. Retrieved from http://inspirationfeed.com/30-profound-quotes-about-death-to-live-a-meaningful-life/
3. Quinn, D. (2018). Meghan McCain [Image]. Retrieved from: https://people.com/politics/john-mccain-daughter-meghan-mccain-cries-casket-arizona-funeral/
4. Nguyen, K. (2012) “Exploring Patient Perspective At End Of Life: Qualitative Interviews With Terminally Ill Patients.” Yale Medicine Thesis Digital Library. 1746. http://elischolar.library.yale.edu/ymtdl/1746
5. ProCon.org. (2013, December 13). Top 10 Pro & Con Arguments. Retrieved from http://euthanasia.procon.org/view.resource.php?resourceID=000126

6. Borgmann, C. (2009) “The Meaning of Life: Belief and Reason in the Abortion Debate” CUNY Academic Works. http://academicworks.cuny.edu/cl_pubs/143