1. 1 Too much technology Too little care Dr Anna Holmes Department of General Practice University of Otago

2. Too much technology : Too little care Talk in threes about why you have come and what you want to explore in this session? 2

3. Too much technology : Too little care Outline Why have you come here? Where would you like to die? From care to clinical detachment and cure What makes a good or bad death? The pressure for euthanasia Advance care planning 3

4. Too much technology : Too little care Where would you like to die? 4

5. Too much technology : Too little care Healing means to make whole. It is the alleviation of suffering in illness by finding new meaning, reconnection and reintegration of self with the family and community. It deals with physical, mental, spiritual and social aspects of the patient. Cure of disease may or may not happen. 5

6. Too much technology : Too little care Cure is the removal of disease by medical or surgical means. It focuses on the pathology of individual organs, systems and people. 6

7. Too much technology : Too little care “He told me there was nothing else he could do and sent me to the hospice. He shouldn’t have taken away my hope” 7

8. Curing is not enough She had been referred for different physical symptoms, bytwo GPs, to four specialists in a year. All investigations had been negative. She finally came to see the last doctor in the practice with a new complaint. This doctor commented on the referrals and asked ‘When did this all begin?’ The patient burst into tears and replied ’When my father died.’ After a period of silence she said ‘Perhaps I need to do some more work on grief.’ 8

9. Too much technology : Too little care What makes a good or bad death? 9

10. Too much technology : Too little care Ten key elements of care for the dying patient 1 Recognition that the patient is dying 2 If possible communicate with patient,family and loved ones 3 Spiritual care 4 Anticipatory prescribing for symptoms - pain, mucus secretions, agitation, nausea,vomiting, brathlessness 5 Review of clinical interventions should be in the patient’s best interests. 6 Hydration review, including the need for commencement or cessation. 7 Nutritional review, including commencement or cessation. 8 Full discussion of the care plan with the patient and relative or carer 9 Regular reassessment of the patient 10 Dignified and respectful care after death for family and patient 10

11. Too much technology : Too little care Why do people seek euthanasia? 11

12. Too much technology : Too little care Advanced Care Planning (ACP) Advance care planning is a process of discussion and shared planning for future health care. It is focused on the individual and involves both the person and the health care professionals responsible for their care. It may also involve the person’s family/whanau and/or carers if that is the person’s wish.

13. Too much technology : Too little care To make a valid Advance Directive Person must be mentally competent Choice made freely Must be informed of options Directive must be written in notes Signed by patient and health professional 13

14. Too much technology : Too little care Advace care planning may include : Advance directives Not for cardiopulmonary resuscitation Living wills Enduring power of attorney 14

15. Symbols of hope 15

17. Too much technology : Too little care 17