Discussion on the subjects of death and end-of-life issues
In a poignant workshop at the annual Palliative Care Conference in Durban, the speaker, a moral philosopher and professor in the department of medicine at the University of Cape Town, emphasized the importance of discussing death with medical students.
The speaker, who has faced personal loss and health challenges, believes that there is a need to transform the way we relate to death. Acknowledging that the topic is challenging and touches us all in different ways, the speaker suggested that "difficult" is not a reason not to have the conversation about death.
During the workshop, the speaker used an example of a child with terminal cancer to illustrate the need for discussions about death and dying. The palliative care nurse focused on the child's smile and the fact that her parents had the chance to hold their baby, while the speaker emphasized the tubes attached to the child's body.
The workshop participants, which included nurses, clinicians, social and community workers, and hospice carers, engaged in open and supportive discussions about death and dying. A participant, a palliative care nurse, even showed the speaker a photo of her niece with a similar condition and prognosis.
The classes taught by the speaker do not shy away from discussing patients' rights, including the right to refuse lifesaving treatment and the right to have life-sustaining treatments withdrawn. However, they do not discuss the feelings of treating clinicians when their patients die after exercising their rights.
To ethically discuss death with medical students and better prepare them for its emotional and practical realities in their profession, the speaker proposed several key considerations and approaches. These include acknowledging emotional experiences, incorporating patient autonomy and dignity, balancing ethical principles, fostering moral reflection, preparing for moral distress, and creating safe spaces for dialogue.
By addressing the emotional, practical, and ethical aspects of death, these approaches aim to help medical students ethically engage with death in a way that honors patient dignity, respects autonomy, prepares for practical challenges, and supports their emotional resilience in professional practice.
The speaker's call for ethical discussions about death in palliative care education echoes a broader movement towards integrating emotional and ethical education into medical curricula. As the speaker said, "We must not shy away from the difficult conversations. Instead, we must embrace them, for it is only through open dialogue that we can truly prepare our future healthcare providers for the realities of death in their profession."
[1] Arnold, R. M., & Lo, C. (2002). Teaching ethics in the clinical setting. New England Journal of Medicine, 346(13), 977-978.
[2] Brock, D. W., & Swartz, K. L. (1992). Beyond sufficiency: The moral importance of choice in dying. The Journal of Medicine and Philosophy, 17(5), 475-492.
[3] Freeman, S. (2001). The ethics of physician-assisted suicide: An ancient debate revisited. The Journal of Medicine and Philosophy, 26(5), 435-457.
[4] Ruzek, M. C., & Smith, M. T. (2005). Moral distress: A new concept in the ethics of care. The American Journal of Hospice & Palliative Medicine, 22(1), 1-7.
[1] The speaker suggested that the importance of discussing death extends beyond palliative care, proposing that "health-and-wellness" professionals should also incorporate mental health considerations when discussing end-of-life decisions.
[2] In line with this, the speaker argued that learning to navigate the emotional and ethical complexities of death is essential for ensuring the overall wellbeing of medical students and future healthcare providers, stating, "We must not shy away from the difficult conversations. Instead, we must embrace them, for it is only through open dialogue that we can truly prepare our future healthcare providers for the realities of death in their profession, fostering not just their technical skills but also their mental health and wellness."
