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LETTERS: Suzie Gillon, Kathryn Mannix, and David A Price Dying on the acute take can be improved BMJ 2007; 334: 652-a [Full text]

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What is dying?

Sunku Guptha   (5 April 2007)

The dying patient.The Cuban experience.

Julio Yasser Valdes Liste, Hiran Morales de Avila ,Damion R .Johnson   (20 April 2007)

What is dying? 5 April 2007
Sunku Guptha, Consultant Physician, Edith Cavell Hospital, Peterborough PE3 9GZ Send response to journal: Re: What is dying?	Dear Sir The art of identifying dying patients is not simple and even experienced doctors find it a daunting task to tease out these patients especially in an acute medical take. How does one define dying? Physiologically, most organs stop growing when we are around 20 years old and start maturing, so in a way we start dying when we are around 20 years old. The process of dying gets more rapid towards old age and is influenced by co-existing chronic diseases. So, a severly ill 50 year old with cardiac failure secondary to IHD,COPD could be classified as dying and also a 95 year old with severe pneumonia with no other medical illness is alo dying but who is more likely to survive treatment of their acute illness is a complex issue. Perhaps palliative care should be provided along with and not instead of active treatment in such patients Competing interests: None declared
The dying patient.The Cuban experience. 20 April 2007
Julio Yasser Valdes Liste, Medical Doctor HOSPITAL UNIVERSITARIO MORON .CIEGO DE AVILA .CUBA.CP67210., Hiran Morales de Avila ,Damion R .Johnson Send response to journal: Re: The dying patient.The Cuban experience.	The anxiety raised by the experience of death is configured with the essential components of the relationship between the dying patient, the family and the medical team. On the part of the sick person, understanding that death is the personal event for excellence, but not always in these sick patients emerges the knowledge of the truth like principles how to adjust the future of their life. The depressive or resigned experience of that distressing period allows him to assume Goethe's statement, according to the one which, "there is no situation that cannot be dignified or take action or endured” (1). Three basic models exist in the dying patient attention (2): The hospital assistance model. It is sociologically identified with the tendency of the current society, in countries that don't have a community system of health as ours, where the family takes to the sick person to die to the hospital because they consider that it is inconvenient that the person dies in the household. In this type of attendance the terminal concept implies that the sick person is unrecoverable and that the action that they should receive are of palliative type, although we recognize this technical perfection, it usually involves the patient in a depersonalization atmosphere and indifference that is not the most convenient thing for these cases. The other model corresponds at the most highest and sophisticated levels in hospital attendance. The hospital institution is so specialized that it limits the practice exclusively on the sick person to the professionals, and it absolutely excludes the sick person's family and social network. Lastly, the bond socially to the traditional concept of the death at home, surrounded by all. The family makes an effort in pulling the sick person from the hospital so that he or she dies at home. In this model the dying patient term doesn't exist, because until the consummation of the death it continues being the sick person. This final model corresponds tothe one practiced in Cuba, assured by our Integral Program of Primary Attention of Health, called by some the domestic model is not only considered as an effective way for the attention of the physical necessities, because it is necessary to keep in mind the parameters of feelings, desires and thoughts manifested previously by the sick person, the family also makes an effort to avoid isolation, nevertheless still there are families that prefer these sick persons to die in the hospital but they continue being the exception in our community. To be much more human, and whenever we have the available sanitary resources, when it is possible, we should suggest this behavior to the relatives, benefits that our sick person will appreciate eternally. References. 1. Borcia Goyanes JJ. El viejo y su futuro. En: Hayflectz I, Barcia D, Miguel J. eds. Aspectos actuales del envejecimiento normal y patológico. Madrid: Ela SL; 2001.p. 413. 2. Guinart Zayas N. Como atender a la familia del enfermo terminal. Rev Cubana Med Gen Integr 2006; 22(1). Competing interests: None declared