Medicalization of Death and Dying

Medicalization of the dying is a form of medical treatment that concentrates on reducing the patient's pain and suffering. It does not delay or speed up the progression of death. However, high-quality, endof-life care is limited, and most of the extant literature focuses on patients with cancer, thereby limiting the prospects for addressing the many important aspects of end-of-life care. This is noted in that hospice organizations serve most Americans dying of cancer and only 10#x0025; of all others.

History

Medicalization of the dying patient is a part of palliative care or hospice care. The concept of hospice is both a philosophy and a specialization that has important historical characteristics that are traceable to the Middle Ages, when in its embryonic form, life-rendering assistance was provided to those who engaged in the pilgrimage to the Holy Land. In the latter portion of the 19th century, a religious order of nuns established a hospice hospital for the dying in Dublin, Ireland, and then later in London, England.

The modern hospice movement originated in the United Kingdom after the founding of St. Christopher's Hospice in 1967 by Dame Ciceley Saunders. Training as a nurse and social worker sensitized Dame Saunders to what she observed and referred to as the patients' total suffering. The intensity of her observations of dying patients and the desire to assist them prompted her to pursue studies that ultimately led to a medical degree, after which she aggressively worked on behalf of pain-suffering patients on the verge of dying.

Hospice care in the United States, which began as volunteer-led movement, has evolved into a significant part of the health care system. From the initial hospital-based palliative care programs that began in the late 1980s, more than 1.2 million individuals and their families received hospice care during 2005. Much hospice care is delivered at the patients' home, but hospice care is also available in home-like hospice residences, nursing homes, assisted living facilities, veterans' facilities, hospitals, as well as prisons.

Symptoms

Patients with serious illness at the end of life should be regularly evaluated by clinicians for pain, breathlessness, anxiety, and depression. Each one of these [Page 703]symptoms can be treated with separate medications, as per palliative care protocols. Following is a short overview of the medications used to treat intractable breathlessness, anxiety, and fear.