More nasogastric tubes and nutritional injections increase the burden on terminally ill patients! Are all the family members the ones who can't let go?
Life has been enough, the only thing I can’t let go of is my family
In recent years, life issues such as advance medical advice and fasting and end of life have gradually received more attention. How to deal with and make decisions in the last moments of a loved one’s life has also become a difficult problem that tests the doctor-patient relationship. Yu Wu Jiaoen, a professor-level attending physician in the Department of Oncology at Linkou Chang Gung Memorial Hospital and director of the Department of Hematology and Oncology at Tucheng Hospital, shared in an exclusive interview with “More Medical Treatments and Less Medical Treatments” that in many cases patients themselves are more accepting than their relatives and friends, and may not choose active treatment. Are relatives and friends willing to let the patient go comfortably?
“Life has gone through enough, and many of the people who can’t let go are their family members!” Dr. Wu Jiaoen pointed out that the difficulty of receiving treatment for hospice patients is beyond imagination. However, out of filial piety to the family members, doctors can only continue treatment. Physicians who are truly trained in palliative care all know the situation of palliative patients. Whether they still choose to have the patient have a nasogastric tube or nutritional injection requires more wisdom to get the best answer.
Dr. Wu Jiaoen explained that if you decide not to receive active anti-cancer treatment, the development of cancer cells will become more and more serious, and one day they will definitely leave. How do patients want to spend their time at this final stage of life? As cancer progresses, patients will inevitably experience loss of appetite and poor appetite, the so-called “cachexia” of cancer, or gastrointestinal obstruction caused by esophageal cancer or gastrointestinal tumors, etc., which will also affect normal digestion.
More nasogastric tubes and more nutrition are only a burden on the patient’s body.
“For such patients, eating more, inserting more nasogastric tubes, and taking nutritional injections is a burden on the patient’s body!” Dr. Wu Jiaoen said, it is just like ordinary people who cannot eat when they have a cold or fever. , if someone forces you to have tube irrigation or nutritional injections at this time, is it really the best medical treatment? From the perspective of tranquility in the oncology department, if the patient and his family agree, the final stage should focus on symptom control as much as possible. Painkillers are given for pain, and sleeping or sedative drugs are given for insomnia, so that the patient can leave comfortably within the last 1-2 weeks or a few days. , instead of forcing him to use the life support system to hold his breath.
Dr. Wu Jiaoen suggested that family members feel a lot of reluctance when facing hospice patients, and they can communicate with doctors to understand that in the last 3-5 days of life, forced feeding may only cause discomfort to the patient, increase the burden on the body, and may not prolong life. . In most cases, life-sustaining medical treatment does not really help patients with terminal cancer. However, due to the relationship between doctors and patients, or even after the death of the patient, the family may accuse the medical staff of not actively treating the patient, and sometimes the clinical treatment is based on the wishes of the family. I hope that family members and medical staff can empathize with each other and make better decisions for patients.
According to the Taiwan Ministry of Health and Welfare, the reason why the number of Taiwanese cancer patients receiving hospice hospitalization or at home is relatively low is related to the national conditions and the lack of correct understanding of hospice care by both doctors and patients. The greatest hope for hospice patients with untreatable cancer is to die well, properly control pain and other symptoms, gain dignity of body, mind and soul, seize the last limited time to fulfill their wishes, and leave peacefully with their families by their side, minimizing ineffective care. Torture and suffering caused by medical treatment and first aid.
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