Care and Understanding of the Dying: A Patient-Centered Approach

Abstract

The author describes the approach he has developed both to provide support to the individuality of the terminally ill cancer patient, and to deepen our understanding of dying and death. This approach emerged through his experiences first as a radiotherapist, then as a psychiatrist serving in the same medical facility. It is vital in this approach to offer one's self exclusively to the patient in a flexible, trusting, and confidential relationship. Similarities and differences with conventional psychotherapy are discussed. The typical course of these contacts is described, along with the considerations that have led to one kind of decision-making as compared with another. Among the specific topics encompassed are indications and contraindications for establishing and maintaining contact, hope, truth-telling, responsiveness to changes in the patient's condition, and relationship with family members. Objectives of working with the terminally ill are explored, with particular emphasis given on support of the patient's dignity and individuality.