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Books have been written on this topic. People have earned PhD degrees learning and writing about it. The Institute for Healthcare Improvement held a National Congress on Improving Care at the End of Life. Governments have sponsored study groups to analyze what constitutes quality of life and death. From this mass of information and assessment there are some key points that can be helpful:

It is agreed that the quality of life and death is improved if the patient and their family are given an opportunity and process to discuss, plan and provide their requests of treatment or lack of treatment much prior to the terminal event. In some Institutions this is described as Levels of Intervention and is dealt with in excruciating detail. The number of levels or their details are not the important issues. The fact that people think about what they want in some inevitable situation and are able to register their opinion is a comfort in itself.

Pain control and comfort management are also essential. Palliative Care Units specialize in developing pain management protocols. The key element  here is that narcotics are used appropriately in sufficient dose and regularity of use to keep the patient comfortable. Narcotic dependency is not an issue in this situation. Nausea and constipation are also treated aggressively.

Shortness of breathe, air hunger, respiratory failure: short term or chronic are terrifying symptoms that must also be well managed. Oxygen therapy at home or in the Nursing Facility should be appropriately arranged.

Management of the symptoms of chronic illnesses such as congestive heart failure, Parkinson's Disease and Diabetes should be ongoing.


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