As the saying goes, “ashes to ashes, dust to dust”. Death is inevitable. At some point we all become the soil. The image above represents death and how we return to the soil at some point. More specifically, the hand in the picture represents us as physiotherapists and the sand going back to the ground represent the terminally ill patients, and the picture is symbolic of how we as physiotherapists guide these patients in their last days. The image being in black and white symbolises how health professionals would need to Colour is a distraction and with this image being in black and white it symbolises the process of simplification and abstraction, a process of boiling down an image or scene to its very essence.
As physiotherapists, we see many patients where nothing can be done for the condition and the most that we can do is to improve the quality of their life. Many would argue that physiotherapy is not necessary for these patients because they are going to die anyway, but they treat the patients because they must. They may not show their beliefs around palliative care but this will reflect in their treatment. It may not be on the same level as that of someone who still has a lot of potential. People may feel as if they are wasting their time.
Physiotherapy may not increase the lifespan of the patients and improve their condition but it definitely will improve the quality of their last days and make the transition from life to death much easier.
Physiotherapy in terminally ill patients doesn’t have a well defined end point end point and may involve both physical and psychological aspects. Physiotherapy will always benefit the patient even when the patient stamina is low, and the end of their life is near. In many cases physiotherapy needs to be terminated due to financial considerations and physiotherapists find themselves having to balance this with ethics of his/her profession (Chigbo et al, 2015).
Allowing the patient the choice of receiving physiotherapy while informing them about all the pros and cons in their last days allows one to be a physiotherapist that ethically practices justice where the patient is treated fairly and giving them the same type of treatment as a patient with good prognosis; and respect for patient autonomy where the patient is allowed to give consent after making an informed decision, always educating the patient. It is also a time where you need to be empathetic toward the patient and their family as this is a tough time for them.
Chigbo, Nnenna & Ezeome, Emmanuel & Onyeka, Tonia & C. Amah, C. (2015). Ethics of physiotherapy practice in terminally ill patients in a developing country, Nigeria. Nigerian journal of clinical practice. 1. S40 – S45. 10.4103/1119-3077.170826.
Sand in Your Hand. (2011). Retrieved from https://bolstablog.wordpress.com/2011/11/21/sand-hand/