I have been teaching medical students about end of life care. These are third year students and had previously received no formal or informal teaching on palliative care, the Liverpool Care Pathway and DNAR decisions.
I was aware that students have their own experiences of death and their own reflections on how it can be managed but was surprised by how difficult some of them found the concept of applying the LCP and its implications. They really pushed me to persuade them how it differs from euthanasia and how it is not ‘giving up’ on a patient. Two of them have been HCAs and were very comfortable with the concept having seen its effective application on a number of occasions. Those who had not experienced death or had lost well young friends or relatives suddenly really struggled not to think of it as actively killing the patient.
Having literally walked onto the ward on my first day as a doctor and being given my first job to certify a patient, I went on to experience the frail, drawn-out deaths of very many patients within my first few months on elderly care. These experiences really made me appreciate the absolute importance of the LCP and how very valuable it is. I 100% feel it is the best course of action in so many cases and is essential in the management and right decision in so many. I attempted to explain this to the students and impress upon them that it is a very positive step in ensuring comfort, dignity, peace and allowing autonomy to the nursing staff at this deeply important time.
Until then, the students’ learning had been focused on being ‘Superheroes’ and how to save lives at all costs. To me it is more heroic to make the tough decisions such as these and do the right, yet difficult thing for these patients at the end of their lives. Making the end of someone's life as comfortable and dignified as possible is far more important than preserving life at all costs.
I hope that introducing these concepts early in their training will help them to become more comfortable with managing death and dying. I finished the session feeling I had shattered their dreams of being the hero doctors portrayed on television, but felt honoured to guide them through their first discussion of this essential aspect of medicine.
Rapid Response:
Re: Let’s talk about dying
I have been teaching medical students about end of life care. These are third year students and had previously received no formal or informal teaching on palliative care, the Liverpool Care Pathway and DNAR decisions.
I was aware that students have their own experiences of death and their own reflections on how it can be managed but was surprised by how difficult some of them found the concept of applying the LCP and its implications. They really pushed me to persuade them how it differs from euthanasia and how it is not ‘giving up’ on a patient. Two of them have been HCAs and were very comfortable with the concept having seen its effective application on a number of occasions. Those who had not experienced death or had lost well young friends or relatives suddenly really struggled not to think of it as actively killing the patient.
Having literally walked onto the ward on my first day as a doctor and being given my first job to certify a patient, I went on to experience the frail, drawn-out deaths of very many patients within my first few months on elderly care. These experiences really made me appreciate the absolute importance of the LCP and how very valuable it is. I 100% feel it is the best course of action in so many cases and is essential in the management and right decision in so many. I attempted to explain this to the students and impress upon them that it is a very positive step in ensuring comfort, dignity, peace and allowing autonomy to the nursing staff at this deeply important time.
Until then, the students’ learning had been focused on being ‘Superheroes’ and how to save lives at all costs. To me it is more heroic to make the tough decisions such as these and do the right, yet difficult thing for these patients at the end of their lives. Making the end of someone's life as comfortable and dignified as possible is far more important than preserving life at all costs.
I hope that introducing these concepts early in their training will help them to become more comfortable with managing death and dying. I finished the session feeling I had shattered their dreams of being the hero doctors portrayed on television, but felt honoured to guide them through their first discussion of this essential aspect of medicine.
Competing interests: No competing interests